Ireland needs a Minister for Sláintecare to clear the land mines

For years, the ministry of health has been the position that is akin to punishment. Former Taoiseach Brian Cowen famously dubbed the brief as Angola, where just as you have cleared one land mine, another goes off. The current situation within the HSE is dire. Workers are burned out, an untold number of important appointments and surgeries have been cancelled. In truth though, the HSE was in a dire situation before COVID with huge waiting lists, a trolley crisis, mass exodus of doctors and nurses and over 700 consultant positions left vacant. Something needs to change, and it will not be solved by bringing in a big 4 consultancy to write a report that is worth a king’s ransom.

The Sláintecare report was published in 2018 and set out a 10-year plan that was agreed upon by all parliamentary parties, meaning that whoever was in government, this plan would be adhered to. It is a roadmap to build a world class health service. The aim is to achieve a universal single-tier health and social care system where everyone has equal access to care based on need and not ability to pay. It will aim to separate the private health system from the public system, but this roadmap is proving unpopular with doctors and private health insurance patients. It will take private money out of the public hospitals, but it should free up capacity and ensure that public patients who need care receive it.

One element of the plan is to digitise the health records and communication within primary and secondary care. The lack of investment in ICT over the last two decades has left us with a highly inefficient system and one that leaves our doctors feeling like they are double jobbing as administrators. Many of them now must perform remote consultations with no full health records in front of them. In some research I carried out with a class colleague, our survey of 170 GPs found that 63.7% of respondents identified infrastructural barriers to remote consultations and 54.2% classified themselves as uncomfortable carrying out remote consultations from a medicolegal point of view. Healthcare has been transformed by the onset of COVID_19, yet we have an archaic system that our doctors and nurses must operate within.

Given we are in a public health emergency, you would expect that most of the population would be familiar with the Junior Minister in charge of public health, but I doubt many would even know his name. Public health should be a priority in the Health Minister’s portfolio. We should invest heavily in our public health infrastructure to ensure that we are much better prepared to respond appropriately to the next public health emergency. It is also likely that in the coming years, we will see more cooperation and collaboration within the EU, which will provide additional funding to member states to improve the overall EU health infrastructure. But national governments must provide the initial investment. It will more than likely require us to have a certain amount of ICU beds per 100,000 and sufficient specialised staff levels to service these beds.

There needs to be more forward planning with the Department of Health and if all Stephen Donnelly must look forward to is the next landmine, Sláintecare needs to have its own minister to take full control of the implementation strategy. The plan is there set out and largely agreed upon by opposition parties. We need someone managing the future path of our healthcare service and we need to make this happen sooner rather than later. We are a third of the way into the implementation strategy and yet the word Sláintecare is thrown around the political discourse, like it somehow means a particular issue or problem is accounted for because it is included in the report.

The vision is there, but the current and future governments need to implement it. Budget overruns are largely caused by inefficacies in the system, so government saying they do not have the money to implement a roadmap to remove the inefficiencies is short-sighted. As the American scholar Warren Bennis defined it, “Leadership is the capacity to translate vision into reality”. If implementing Sláintecare is seen as a key priority, it needs a leader, someone to remove the land mines for the HSE thus providing a world class healthcare service to the Irish population.