Jury out on Sláintecare

How is Sláintecare progressing? Well, it depends on who you ask. The press release issued by the Department of Health on 28 March to mark the publication of the Sláintecare Progress Report 2022 focused on the positives.

The Department highlighted the new consultant contract; the abolition of public hospital inpatient charges for children; the approval in principle for elective hospitals; and a reduction of 11 per cent in waiting lists for those exceeding Sláintecare maximum wait times.

It also noted the free contraception scheme, increasing capacity (hospital and critical care beds), and the appointment of additional frontline staff.

The report points out that 83.3 per cent of 100 ‘deliverables’ (health service-speak for initiatives or projects) were “delivered or have progressed as planned or with minor delays”.

The report added that 16 deliverables (13 per cent) were progressing “with significant challenges and four deliverables (3 per cent) have been impacted by external dependencies”, which is to say they experienced major delays.

Unsurprisingly, the media (including a breaking news story in the Medical Independent) chose to focus on the delays.

A headline in The Irish Times published the day after the report was launched read, ‘Over 40 per cent of Sláintecare reforms suffered delay last year, report finds.’

In addition to the projects which experienced major delays, The Irish Times also included the 19 per cent which had minor delays, and 6 per cent which were completed later than planned, to arrive at its headline percentage. In the report, the latter two categories came under the 83.3 per cent of projects that were developing more or less as planned.

The new consultant contract was an area that arrived later than planned. However, it was highlighted by the Minister for Health Stephen Donnelly and the Department because of its significance in delivering a key aim of Sláintecare, which is the removal of private practice from public hospitals. The extended working hours under the contract will also “enable the health service to maintain efficient and timely patient flow out-of-hours and at weekends, enhance senior decision-maker presence on-site and reduce waiting times by maximising capacity in our hospitals”, according to the report. It is probably too soon to judge whether this will become a reality. As reported in this newspaper, many consultants have reacted negatively to the new contract, and the representative bodies remain concerned about onerous rosters.

In his foreword to the report, the Minister also refers to the planned extension of free GP visits in 2023 to almost half the population as a “tangible measure” that will make a “real, immediate difference to patients”. However, GPs continue to have significant reservations about this plan, which they say could result in waiting lists for patients, similar to those in the UK.

An academic paper published in 2021 by Prof Steve Thomas (PhD) and colleagues at the Centre for Health Policy and Management, Trinity College Dublin, evaluated the design and progress of the Sláintecare recommendations to mid-2020. The paper stated the “policy, phasing, and timelines have changed” in the early years of the strategy. It added that the “pursuit of lowering access costs to care and entitlements seems to have taken a back seat to other areas of work”. The success or otherwise of Sláintecare will largely depend on how the health service manages to expand eligibility. As GPs have pointed out, this will require a large increase in existing capacity. The jury on this matter is likely to be out for some time to come.