Manifesto review 7 – health and Fine Gael

Full disclosure – I’m a Fine Gael member. I’m not very impressed with the health policies in their manifesto, as you will see, but I support them, partly because I approve  of the way they pulled our economy back from the edge from 2011 onwards.

Fine Gael’s manifesto is out. It’s a 140 page tome, with a long section on health policy. Like Fianna Fáil they talk about health in four headings, and an appendix with detailed costs. Unlike Fianna Fáil, they have been much more systematic in what they cover. Their overall message is that they have a ‘plan for Universal Healthcare – for access to quality preventative, primary, curative, rehabilitative and end-of-life healthcare that is timely and affordable for everyone’. This is very comprehensive, and ambitious. I’m not going to list every item, but will focus on some highlights and comment on these.

More Resources and Staff and Better Infrastructure for Health Services

They plan to increase health spending steadily, all going well, over th next five years. They will hire 4,400 more staff, although few of these seem to be in community services, and very few in general practice. They will encourage HSE to work with the private sector to roll out a decent health IT system, including electronic health records. Renua is the only other party to suggest this critical piece of investment. In 2017, there will be a capital review and a bed capacity review, which will guide hospital bed numbers. Both of these are sorely needed. They still plan for a competitive private health insurance market, which would be nice, but would not be a priority for me. Their plan is to fix the health care system, as outlined in the next section, come up with a better funding model, and then move to universal health care.

 Health Reform Programme

They still plan to abolish HSE. This is  really really bad idea. Having worked there, part time for two years, I quite understand why they feel like this, but it is still a bad idea. It is is not possible to simultaneously abolish HSE, and reform the delivery of health care. HSE itself is far from perfect, though it is improving, but abolishing it will freeze all health service change for at least three years. Making hospital groups work (this is at all, not better)  is not a bad idea, although this should have been done two years ago. The notion of keeping the voluntary hospital boards, and setting up hospital group boards, is entirely incoherent, and a recipe for chaos. Reducing drug costs, and limiting prescription charges are good ideas. They suggest an expanded role of nurses in hospitals, which I approve of, but say little about nurses in primary care. A stronger system of performance management for hospitals might be a good idea, although there is little mention of clinical governance. They mention open disclosure, that is telling patients about errors, which I strongly support.

A Decisive Shift Towards Primary and Community Care

For primary care, Fine Gael propose more primary care centers, supports for general practice, including more training places, and a wider range of services, as well as more chronic disease management,  in general practice. Where it falls down, with a bang, is in the idea of setting up multi-disciplinary teams in the primary care centers, with no mention of the GPs. Clinical governance is essential for primary care, and most of it, in my view, needs to come from the GPs. They plan free GP care for those under 18, which I believe is not feasible without quite a lot more GPs and a lot more staff in general practice. No serious budget for this is suggested anywhere.

Mental health gets its own subsection. There’s a lot of detail, but key pieces are more resources, more of a focus on prevention,and early intervention, with a number of specific programs identified, including the Jigsaw program, and some of the community based programs developed with Genio over the last few years.

Improving the Health and Well-being of the Nation

Key proposals here are the new Alcohol bill, a sugar tax, further reductions in smoking, an expanded vaccination program, and support for physical activity, obesity prevention and sexual health, and and a ‘Fit for Work’ program (to support people with illness and disability in working). I don’t like one phrase ‘to consider additional measures to tackle excess alcohol consumption and misuse’ which comes straight from the drinks industry. (What we need is a reduction in overall consumption too). They also undertake to support a range of clinical initiatives, cancer care, the national maternity strategy, dementia care, rehabilitation, and palliative care. These are, mostly, sensible suggestions, and I would support them, by and large.

Overall, there are good ideas here, but also some impressively bad ones. It is far too hospital focused. In fairness, so are many Irish people, and much of the Irish media, but it is still a mistake. There is too much emphasis on changing institutions and organizations, and little sign that they realize that the hard bit, and the important bit, is changing what people actually do on the ground. There are ambitious plans for general practice, with no real resources behind them. Could do better!


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