Explained: What is Sláintecare and what’s the controversy about?

Sláintecare is the initiative aimed at getting rid of the two-tier health system in Ireland
Explained: What is Sláintecare and what’s the controversy about?

Muireann Duffy

Sláintecare has been hanging around the political agenda for years now, but recent resignations of key personnel working in the programme have brought the initiative back into focus.

The programme has faced so many delays that it's easy to forget what it was set up to achieve. Here's everything you need to know about Sláintecare as it faces its latest controversy...

What is Sláintecare?

In short, Sláintecare is an initiative aimed at abolishing the State's two-tier health system, replacing it instead with a universal healthcare model. Such set-ups can be seen across Europe, with the UK's National Health Service (NHS) seen as prime example.

The idea for the new programme came about following the 2016 general election, with all Oireachtas parties supporting the reform.

Sláintecare's broad aims were to improve the experience of patients/service users, improve the experience of clinicians, lower healthcare costs and achieve better healthcare outcomes. A major point in achieving these goals would be tackling the discrepancy between waiting times for patients with private health insurance versus public patients who often face long waiting times to access treatments and services.

Another key element of the programme is the establishment of Regional Health Areas which will break the State into six areas, each responsible for its own budget, planning and hospital/community care delivery, going back to the system which existed before the establishment of the HSE.

An image showing the six Regional Health Areas. Photo: Department of Health Twitter

How is Sláintecare going to be made a reality?

The specifics of the programme were laid out in the Sláintecare report, published in May 2017 by the Oireachtas Committee on the Future of Healthcare.

Social Democrats co-leader Róisin Shortall chaired the committee which included 13 other TDs from across the political parties, tasked with considering how best to ensure access to an "affordable, universal, single-tier healthcare system, in which patients are treated promptly on the basis of need, rather than ability to pay".

The Sláintecare report stated 10 key recommendations for the programme, covering aspects such as funding, implementation and the expansion of both primary and social care services. Each recommendation was further broken down into key markers - such as universal palliative care and the removal of inpatient charges for public hospital care - many of which were costed and given dates by which time they should be achieved within a 10-year period.

The Government responded to the report by publishing the Sláintecare Implementation Strategy in July 2018, covering the actions to be taken in the first three years of the timeline.

Who is overseeing the programme?

The Department of Health has overall responsibility for Sláintecare, but the day-to-day implementation, as the name suggests, lies with the Sláintecare Programme Implementation Office. Established in 2018, the group's first task was to review and refine the aforementioned Sláintecare Implementation Strategy, breaking down the three-year goals into more detailed Action Plans, to be published and updated each year.

The Sláintecare Implementation Advisory Council (SIAC) is an independent group, established in October 2018 to provide advice and support to the Implementation Office. The SIAC began with 21 members, combining "patient/service user representatives, senior health service leaders, clinical leadership, and a number of independent change experts from outside the health service".

As the existing healthcare model, the HSE has a role to play in matters, however, as the Sláintecare programme looks to radically alter the health service, there have long been reports of resistance from the current executive.

And what's the hold up?

As with most things, one of the issues holding up the implementation of the plan is money.

The reforms laid out in the Sláintecare report would transform the healthcare system, tackling issues that have blighted the health service for decades. However, these changes will not come cheap.

In addition, sticking points like the establishment of Regional Health Areas and the approach to universal healthcare have divided stakeholders, while wider healthcare issues, such as the shortage of consultants, GPs and hospital beds, also feed into the problem as long waiting lists cannot be properly addressed if the resources are not available.

So, what's the controversy over now?

Sláintecare has been back in the headlines in recent weeks after key personnel involved in the programme and the SIAC resigned.

On September 8th, the programme's executive director Laura Magahy and the SIAC's chair, Prof Tom Keane separately announced their decisions to step down from their respective roles. Just three weeks later, another SIAC member, Prof Anthony O'Connor also confirmed his resignation.

According to The Irish Times, Prof Keane attributed his decision to his unhappiness over how the programme was being delivered, stating: "Sadly, I have come to conclude that the requirements for implementing this unprecedented programme for change are seriously lacking."

Laura Magahy and Prof Tom Keane both resigned from their respective positions in early September.

Meanwhile, Prof O'Connor predicted the initiative is "doomed to fail" in his resignation letter and said the regionalisation of healthcare "will not happen".

Some SIAC members expressed their "shock, regret and concern" in a statement issued following Prof Keane and Ms Magahy's resignations, while Dr Eddie Molloy, one of the group members who signed the statement, told RTÉ that the Minister for Health's "resistance and delay" in implementing the Regional Health Areas was likely a factor.

The departures are significant as they raise questions regarding the feasibility of Sláintecare as a whole when some of the programme's key drivers opt to walk away.

How do we get the show back on the road?

It's clear from the comments made following the resignations that there is a lot of frustration over the slow progress of the programme, so delivering key aspects in line with the yearly Action Plan and the three-year Sláintecare Implementation Strategy is a must if the Government wants to prove the whole thing isn't falling apart.

To do this, the Government is working to tick some recommendations off the to-do list; the first being the announcement of three elective hospital sites in Dublin, Galway and Cork next week.

Budget 2022, which will be announced on October 12th, is expected to include funding to reverse the impact the pandemic has had on waiting lists, after which Mr Donnelly is due to confirm a five-year plan on the elimination of these lists entirely.

However, writing in The Irish Times this weekend, group clinical director of the RCSI Hospital Group, Prof Patrick Broe said parts of the programme are being "cherry-picked" so it appears targets are being met despite overall progress being slow.

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