It’s offensive to tell anyone in the health service they are resistant to change after what they have gone through in the past 18 months.
quiet revolution has taken place from the local pharmacist to the clinical nurse manager. Change happened during Covid-19 because it had to.
Aside from the major achievements such as the national testing and vaccination system, there were smaller ones too. GPs can now refer patients for particular diagnostic tests in hospitals, where previously they had to be sent to consultants.
Joined-up thinking between acute hospitals and community hospitals saw patients in need of 24-hour care – previously disparagingly referred to as ‘bed blockers’ – provided with the care they required before returning home.
Now the pandemic is coming to an end, there is an impetus to bring about fundamental reform. Heading into the crisis with the longest treatment waiting lists in Europe, there are now more than 900,000 people waiting to be treated.
At the heart of the latest planned reform is Sláintecare: a cross-party plan to end the two-tier public and private system, essentially ramping up public hospitals to ensure public patients are treated on the basis of need, rather than ability to pay.
Nobody is against universal care. But a slogan is one thing, making it happen in the world of medical politics and vested interests is another matter.
Sláintecare has come under the spotlight following the resignation of Laura Magahy, its executive director who was tasked with its implementation, and Dr Tom Keane, the chairman of the Sláintecare Implementation Advisory Council (SIAC).
Keane said he felt the requirements for implementing the changes “are seriously lacking”.
Contrary to the picture being presented by some of its more microphone-craving members, who pledge they will die in the ditches for reform, SIAC is not the board of Sláintecare. It is an advisory group, with a limited role, which only met 10 times in three years.
The term of office of Keane and the rest of the members was due to run out next month.
The melodramatic pleas of SIAC members to be kept on is viewed with some amusement by senior health figures who were barely aware of SIAC’s existence.
Magahy, something of a ‘quango queen’, who has worked on a variety of projects and State boards over the course of her career, hasn’t provided a substantial explanation for her departure.
She cited “slow progress” in new regional structures for the health service, the use of technology and waiting lists. She’s largely right on those three, but there is context. Just days before her resignation, Magahy herself presented a progress report saying there was progress on 97pc of the measures.
Putting regional structures in place was deliberately delayed during the pandemic, with the analogy being an army doesn’t change its organisation mid-war.
However, there is a paranoia around going anywhere near an old health board system.
A hybrid version is likely – involving matching the six hospital groups with the nine community healthcare organisations which look after care outside the hospitals, such as primary care, social care and mental health.
There will be a level of autonomy on budgets – but policy and spending plans will be directed nationally.
The HSE hacking affair starkly exposed how chronically underfunded e-health has been over years, so there’s no argument there either.
The waiting lists are a major blockage, with a short-term plan to be announced in the coming weeks.
There is particular bemusement at the SIAC departures at a time when there were reform and massive funding increases from Covid-19 to be claimed as Sláintecare wins.
But as the HSE got on with the pandemic, the Sláintecare side failed to make its impact felt.
The narrative around a resistance to change within the health service is true, say figures at the highest level, but they add that it would be exceptionally naive to expect otherwise, and that’s why you work through difficulties.
A key plank of Sláintecare is a public-only contract for hospital consultants.
The contract will ultimately be worth up to €250,000 and will essentially ban senior doctors in public hospitals from also treating private patients.
But the hospital consultants are digging in on defending their ability to treat private patients in talks on a new contract.
The negotiations are described as “particularly fraught” and, after some heated exchanges, are now being chaired by an independent mediator, barrister Marguerite Bolger.
She has just been appointed as a High Court judge, so it’s unclear whether she will be in a position to see the negotiations through.
The Department of Health has conceded ground on some of the dumber aspects of a draft contract, which have caused unnecessary tension.
A gagging clause, requiring medics to get permission to comment publicly, was dropped. Likewise, a condition that any research done in a public hospital was HSE intellectual property, as it would effectively have prevented a doctor from contributing to a medical paper.
The consultants also want a pay disparity between consultants hired after 2012, the so-called B-contract, to be levelled off. It’s on the table but not the deal-breaker.
The fundamental conflict though is around consultants having to give up private practice.
Multiple senior sources say this is the stumbling block with such comments as: “They do not want to give up any private practice”; “Taking private practice out of the public system goes to the heart of Sláintecare”; “They want to keep their private clinics but that’s not universal healthcare.”
Medical politics and money is trickier than anything going on in Leinster House.