On the 24 March 2020, Taoiseach Leo Varadkar announced that private hospitals would operate as public during the COVID-19 Emergency. This measure was introduced to bring an additional 2,000 beds and thousands of healthcare staff into the public system in a bid to prevent our public hospitals from becoming overwhelmed due to increases in cases requiring hospitalisation. Following the announcement of the new measures, Minister for Health Simon Harris explained:
‘Patients with this virus will be treated for free and they’ll be treated as part of a single national hospital service…There can be no room for public versus private when it comes to pandemic.’
For the first time in the history of the state, and for the duration of the pandemic, Ireland now has a single-tier health system. This move has generated debate on what the future of the health system should be post-pandemic. Among experts, there has been renewed calls for the implementation of Sláintecare, with many stating that there should be no return to the inequitable health system we had pre COVID-19.
The Sláintecare Report, published in May 2017, was developed by the Committee on the Future of Healthcare, which included TDs from across the political spectrum. The task of the Committee was to ‘consider how best to ensure that, in future, everyone has 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.’
Interestingly, recommendations made in the Sláintecare Report – including equality of treatment, the removal of inpatient charges for public hospital care, and the elimination of private care from public hospitals – are key measures which have been introduced by the current government in response to the COVID-19 Emergency. According to some, this is not a coincidence.
Future of the Irish Healthcare System
As Anthony O'Connor, a consultant and member of the Sláintecare Advisory Council, explains ‘any success our health service has had in recent weeks has come from embedding Sláintecare’s core principles…Citizens are getting the right care, in the right place, at the right time, delivered with empathy, equity and efficiency using the best technology.’
For him, Sláintecare will be more relevant post COVID-19 than ever before, as we face into even longer waiting lists than normal and tackle delayed diagnosis of cancers and other chronic illnesses.
The potential to use the current crisis as an opportunity to end divisions within the healthcare system is also recognised by Professor John Browne, Director of the National Health Services Research Institute in Ireland. He maintains that ‘we have to take private practice out of our public healthcare system. It’s remarkable that such a divisive, inefficient, and unethical system still persists, even though the public consistently votes for political parties that reject it in their manifestos’.
Of course, not everyone shares this view. Professor John Crown, a Dublin-based consultant oncologist, agrees that our hospital system is unfair but does not think the implementation of Sláintecare, including the removal of private practice from public hospitals, will address this inequality. He maintains that ‘Only a true reform of the HSE funding model can fix the problems, and that is exactly what Sláintecare doesn’t do.’ Instead, Professor Crown advocates a universal single-tier social insurance model, which he describes as ‘a hybrid between the German, French and Canadian systems.’ He rejects that this is unfeasible, stating that we already have it in Ireland in the form of the VHI, but acknowledges that it may cost more.
Universal Health Insurance to Universal Healthcare
A similar funding model, Universal Health Insurance, was committed to in the 2011 Programme for Government. However, a significant difference between this and what Professor Crown proposes is that The Path to Universal Healthcare: White Paper on Universal Health Insurance included competing health insurers, including those operating on a for-profit basis. The Universal Health Insurance model was later abandoned by government after an ESRI study, published in November 2015, found that the overall level of Irish healthcare expenditure would increase by up to 11 per cent. As a result, government policy changed from Universal Health Insurance to Universal Healthcare.
In June 2016, the Dáil agreed to establish the all-party Committee on the Future of Healthcare in order to gain cross-party consensus on the direction of health policy in Ireland. The Committee published its Sláintecare Report the following May.
Although the government has been criticised for failing to implement Sláintecare in a timely manner, A draft document between Fianna Fáil and Fine Gael to facilitate negotiations with other parties on a plan to recover, rebuild and renew Ireland after the COVID-19 Emergency offers hope that Sláintecare will be implemented as a matter of priority post-pandemic.
For example, in introducing the 10 missions for a new government, it states:
‘We know that there is no going back to the old way of doing things. Radical actions have been taken to protect as many people as possible, and new ways of doing things have been found in a time of crisis.’
Furthermore, it explains that once the pandemic has passed, the national response will be reviewed to ‘see what lessons can be learnt, and how this can improve our future healthcare provision.’
The COVID-19 Emergency has highlighted the limited capacity of our public healthcare system and acknowledged that private practice in public hospitals is unequal and unfair. Remarkably, action to address these issues – including equality of treatment, the removal of inpatient charges for public hospital care, and the elimination of private care from public hospitals – was taken quickly in the face of the current crisis, demonstrating the ability of the government to implement radical actions when needed.
Looking to the health service post-pandemic, we will need government to implement these measures permanently, as well as introduce further recommendations outlined in Sláintecare, such as universal access to GP care without charge, in order to reduce inequalities and provide healthcare protection in what is predicted to be a significant economic recession.
While there is expected to be resistance to this, particularly from health insurance providers, consultants and General Practitioners, a single-tier public health system does not mean the abolishment of private healthcare in Ireland. As Professor John Browne explains, ‘there is more than enough room for a niche private sector providing optional services alongside a properly funded public system where no one has to wait long periods for vital care.’
However, the structure that this will take, along with decisions regarding contracts to provide universal GP care and the expansion of public-only consultant contracts, will need to be transparent, in the patient and taxpayers interest, with negotiations from all relevant healthcare representative bodies. These essential steps have been missing from the COVID-19 response to date and have led to confusion and frustration within the health service, especially among full-time private consultants and their patients.
Kirsty Doyle is a Researcher at TASC, working in the area of health inequalities. She is also conducting a PhD in Sociology part-time at Waterford Institute of Technology, focusing on the regulation of alcohol-related behaviour in the night-time economy. Kirsty has an MA in Sociology and Geography from Maynooth University and has previously worked at the Health Promotion Research Centre in NUI Galway.