Roisin Shortall
An historic opportunity to transform the public health system should not be allowed to slip away, writes Roisin Shortall
AS the heartbreaking human cost of the CervicalCheck controversy reminds us, accountability within our health service is not some abstract notion.
It is a testament to the courage and selflessness of Vicky Phelan that her clear message to the Public Accounts Committee last Wednesday was that she wants accountability, not revenge.
Yet in the heat of the political uproar a determined focus on achieving that accountability in our health service is getting lost in the clamour for heads.
It’s now a year since the publication of Slaintecare, a 10-year vision and plan for a radically reformed health system which has accountability at its very core.
Slaintecare is the work of a cross-party Oireachtas committee which I had the privilege of chairing. If implemented in full, it will deliver for Ireland the sort of accountable, fair and effective public health system that we so desperately need and deserve — and which most of our European neighbours currently enjoy.
The Slaintecare model — one that is tried and tested elsewhere — is for a universal, single tier healthcare system where patients are treated promptly and effectively on the basis of medical need, rather than ability to pay.
In addition to fair access, the reforms are about shifting the delivery of our health services away from overcrowded and costly acute hospitals towards primary and social care services in local communities.
It makes complete sense for services like minor injury care, chronic illness management, diagnostic services like scans and X-rays as well as mental health services, to be available through the local primary and social-care services.
But in addition to these reforms, Slaintecare is very explicit about the urgent need to legislate for accountability right across the health service from the Minister for Health, to senior management to clinicians.
It proposes an entirely new clinical governance framework within the health service with greatly improved structures and processes. This will provide much-needed clarity on reporting relationships — and a clear line of accountability.
For example, Slaintecare recommended that an independent oversight board for the HSE be reinstated. It also recommended that the current highly centralised, command and control management structure would be slimmed down and that legal responsibility for service provision, decision-making and budgetary control would be devolved to local regional managers to support open communication, integration and adaptation to change.
Since Slaintecare was launched, the Minister for Health has spoken many times of his commitment to it as the only game in town. I believe he is sincere. However his positive words have not been matched by action. For example, it would seem that it took the CervicalCheck crisis to put any urgency into the production of a bill to reinstate the HSE board.
But a new HSE board is by no means a panacea, it’s only one element of improved accountability.
What about the Minister’s accountability for the provision of adequate health services? What about legal accountability for the performance of senior managers so that there are consequences when things go wrong? And what about legal accountability for clinicians when the quality of care is not up to standard? If politicians, from all sides, are serious about accountability, then they should be demanding that this legislation be expedited.
While there has been some movement on other aspects of Slaintecare, progress has been painfully slow. An expert MESSAGE: Vicky Phelan group set up to examine the impact of separating private practice from the public hospital system — a central recommendation of Slaintecare — is due to report in September.
Likewise, a public consultation is underway on how better to align community and hospital structures to ensure better integration of health services, as well as better value for money.
However, the key recommendation of Slaintecare was to set up an independent Implementation Office, headed by an experienced leader in health reform and with a separate budget and focus on making the much-needed reforms happen. As we approach the first anniversary of the publication of the Slaintecare report, this office has not yet been established. In respect of a senior person to lead it, the Minister’s mantra remains that this appointment will happen soon.
The main fear is that the Government will cherry pick different elements of Slaintecare. Will vested interests within the system be allowed to continue to block the reforms needed to build a health system that is fair, accountable and efficient? Do we have the political will to create a health service that we can actually be proud of ?
Slaintecare is a product of unprecedented political co-operation in facing up to the deep-rooted cultural problems within our health service. It is a 10-year, fully-costed plan to provide the kind of modern and accessible health service which this country has lacked for so long. There is no alternative solution.
Are we seriously going to let this historic opportunity for our health service to slip away?
We owe it to Vicky Phelan and countless others like her to do better.
‘Do we have the political will to create a service we can be proud of?’