Galway’s public health services are on the medical equivalent of a life support machine. The A&E department of University Hospital Galway is so over-run that it is asking people not to come this week. People are tragically ending up in the Corrib due to lack of access to mental health services. Those with dementia are picking up infectious diseases while stuck in hospital beds that cost the HSE over 10,000 euro per month, preventable with a modest investment in their homes and home care packages. On a daily basis, patients and their families travel from all over the West of Ireland to an overloaded Galway hospital to receive basic healthcare that doesn’t need to be administered in a hospital environment. To add insult to injury, up-front charges for GPs and A&E, as well as the cost of health insurance are spiraling upwards, adding to already strained family budgets.
Unfortunately, this outcome was predictable from the early 1950s when Ireland took a different path to a post-war Britain that launched the National Health Service (NHS). While the modern NHS has its problems, it is still an excellent publicly-run health system that is financed by income taxes rather than charging people for care when they need it. It is a little known fact that the Irish government of the day almost took the same approach, but it was fought by the Department of Finance who said we couldn’t afford it, and by the Church which feared losing control of the hospitals. It turns out that we couldn’t afford not to build an Irish NHS we are now paying the cost of that decision with an expensive and unfair health service that has cost taxpayers unnecessary billions and, more importantly, unnecessarily cost our people healthy years on this earth with their loved ones.
A Chinese proverb goes that that the best time to plant a tree was decades ago and the second best time is today.
This week, the Oireachtas Committee on the Future of Healthcare, chaired by my Social Democrats colleague Róisín Shortall TD, published Sláintecare – the first coherent, long term plan in the history of the state that has cross-political support. The ambitious ten-year plan would see us get the majority of our healthcare (such as diabetes, COPD, dialysis appointments as well as minor injuries, blood tests and scans) from our GPs, small community clinics and primary care centres. All evidence shows that this will improve people’s health and will be more convenient, as services will be delivered to all closer to home. The plan would also ensure that at least 10% of Ireland’s healthcare budget will be invested in mental health, an area with huge need for expanded services.
What could this mean in practice for people in Galway? It won’t solve our issues overnight, but as the proposed upfront investment hits the ground, waiting lists would begin getting shorter. New GP clinics and primary care centres with a broad range of services would be set up all over the county. Your local health centre would see increases in staffing levels and opening hours. Primary and community care teams would be strengthened – that would improve your access to public health nurses, counselors, eye doctors, speech and language therapists, dentists and home care assistants. In the NHS, where I work on health reform, we are even safely providing minor surgery and chemotherapy in the community.
Galway hospital would get much needed investment and refurbishment, and this plan could end the debate on Merlin Park. The question isn’t whether a brand new hospital, if fully staffed, would benefit Galway. The answer to that is obviously yes. The real question is what is the best way to spend limited money to improve the health of Galwegians, and the direction from Sláintecare – and also the direction we are taking in the NHS – would suggest that strengthening primary care is the best thing to do for people’s health and the best way to take pressure off hospitals.
Speaking of money, how would this impact your pocket? There is no question that we need to make an upfront investment to make this work, and the next few budgets would need to prioritise healthcare over tax cuts, something politicians will have to discuss honestly with the electorate. The direct costs of health – admission charges, GP charges, prescription charges – would go down, and many families should feel comfortable giving up their health insurance as services improve.
The measures outlined in the report will eventually save money. For every euro we invest in primary care, we save multiples of that due to avoided hospital admissions and the fact that the same treatment is being given by less expensive staff in less expensive buildings. If we don’t make this investment and continue with an expensive hospital based system, costs will balloon out of control, people will die unnecessarily, and the differences between care provided to rich and poor will increase.
A report by itself changes nothing and the focus must move quickly to implementation. The committee see an implementation office being set up to make the plan a reality. I’ve been involved in similar implementation offices in the NHS and they do work very well if they are well-led, ruthless about priorities and make decisions based on evidence and data. This is a once in a generation opportunity to correct the mistake that was made in the 50s not to build a great public health service in Ireland. Let’s move forward and make it happen!
Niall Ó Tuathail was a recent general election candidate for the Social Democrats. He works with the English NHS on health reform.
First published in the Galway Advertiser