Friday 15 December 2017

Welcome to Health, Leo - now here's 5 issues to tackle first

Leo Varadkar has only been Minister for Health for a week but already he has a mountain of to-do lists and a stream of people keen to air their grievances.

He has acknowledged his new post is "challenging" and that it is not realistic to expect he can solve all the health service's problems before the next election, but he believes he can make a big difference.

Let's hope so. So what should his top five priorities be?

1 Getting health staff on board

The heart of any health system is the staff who work in it. There are approximately 100,000 employed by our health services, and currently morale is at an all-time low.

Varadkar's predecessor Dr James Reilly had well-publicised fallouts with consultants, GPs and trainee nurses.

It is vital that the new Minister, a trained doctor himself, builds bridges with staff and involves them in the decision-making process on changes to the services they provide.

First on that list should be talking to GPs, who were not invited to negotiate on a new GP contract to provide free GP care for under-6s or in talks on the surprise planned extension of free GP care to over-70s ahead of those with chronic illnesses.

If the Government is to reach its target of providing free GP care to the entire population by 2016, Minister Varadkar needs to engage with GPs who feel totally demoralised, claim they are struggling financially and have brighter prospects abroad.

The Minister also needs to address the recruitment and retention of junior doctors and consultants as a priority.

It has become increasingly more difficult to staff our hospitals with high quality doctors as they seek better working conditions, and pay, abroad.

2 Medical cards

One of the death knells for Reilly's reign was due to the medical card fiasco, particularly the loss of discretionary medical cards for those with serious illnesses or conditions.

It may have calmed down now, but the new Minister needs to find a comprehensive solution to the issue as soon as possible or his tenure may be shorter than planned.

The HSE does not have an infinite budget and the fact that over 40pc of the population now has a medical or GP visit card puts huge strain on it.

However, constantly frightening vulnerable groups with endless card reviews, missing deadlines on free GP care and rash announcements on extending that free care to certain age groups, as opposed to those with more pressing medical needs, must stop.

3 Cutting costs

The HSE is due to run over budget by an estimated €500m by year end and the Government has already acknowledged it will need a supplementary budget.

Failure to keep the budget under control was one of Reilly's downfalls. To be fair, the HSE has seen almost €4bn removed from its budget since the recession hit, and rising demand in many areas.

However, services are under severe pressure and waiting lists are creeping up again.

Despite this, there is still high levels of wastage in some areas, seemingly excessive absenteeism in some staff areas and regions, and high agency costs for locums.

Tackling health costs and ensuring the HSE receives an adequate budget in the first place must be a major priority.

4 Implementing health strategies and legislation

We are great at publishing heath strategies - but very poor at implementing them.

The National Rare Disease Plan 2014-2018 was launched earlier this month with little fanfare and it is likely it will go the way of so many strategies unless the Minister prioritises its implementation.

He must, similarly, put the pressure on to bring through much-delayed healthcare legislation on areas such as unique health identifiers, electronic records, surrogacy, IVF, and stem-cell research.


There are increasing doubts that the Government's Universal Health Insurance (UHI) plan will ever come to fruition, never mind by the 2019 target deadline.

The Minister needs to get a handle on whether the current plans will really work, and how costs can be kept down.

In the meantime, he really needs to address the escalating costs of private health insurance and the continuing exit of younger, healthier customers.

Reilly may have introduced late entry loading just before he left, which will penalise those who take out insurance later in life, but affordability is really the key issue.

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