If I were Finance Minister…

We see the billions and billions going into the HSE every year and think, surely, we should have a world-class healthcare system for what we’re spending

At the time of writing the latest Budget hasn’t yet been announced. But the general gist of what it will contain is already pretty predictable, given all the kites flying around the media right now. It can be expected to be a ‘one for everyone in the audience’ Budget, full of giveaways and goodies, a sweet little treat for the electorate to hopefully remember as we go straight into an election after Christmas, if not before. 

As with so many things, one can feel certain that we would do a much better job of things if we were in charge and it can be tempting to play ‘fantasy Budget announcement’. This is a little akin to fantasy football – we see the billions and billions going into the HSE every year and think, surely, we should have a world-class healthcare system for what we’re spending.

Don’t get me wrong, much of the money flowing in recent years has been visible and successful. In the community, we have much greater access to services like imaging and chronic disease hubs and we’re gorging on them like kids with sweets at a party, for fear that they’ll be snatched away at any moment. It has been such a pleasant change to not always have to ask about a patient’s level of private insurance cover or ability to pay when deciding on a treatment plan. 

I’m also delighted that more funding is going into women’s health, with free contraception likely to be extended. This has been a fantastic scheme so far – it has been brilliant to see young women choosing more effective, longer-lasting contraception that they may have not been able to afford. It is also likely that there will be a similar scheme for hormone replacement therapy (HRT). Although, I obviously hugely welcome the greater dialogue around this and access to treatment, the cynic in me feels that the focus has largely been chosen to target the votes of the affluent middle classes who are able to shout the loudest about such issues.

I’m sure this Budget will be full of lots of lovely goodies targeted at nice middle-class people in the hopes of getting a first, second, or even third preference, be it in the form of energy credits, tax cuts, or the aforementioned free HRT

I know there are fewer votes and headlines in allocating funding based on things as boring as clinical need, but I have a few suggestions on what I would do if I were in charge of the country’s finances. Firstly, I would give all those with named chronic diseases access to the hugely successful chronic disease management programme, not just those with medical cards. It is now clear that even our most affluent patients are receiving less comprehensive, coordinated care than those who are eligible for the programme. It has already been done with gestational diabetes, so it is possible if the money was there. I would increase access to the GLP-1 agonists, such as Ozempic and Saxenda, which have the potential to be revolutionary in the treatment of obesity and other chronic diseases. We need to figure out how they are going to fit into our clinical practice into the future.  I would increase access to services in the community such as psychology, dietetics, and physiotherapy – currently, these are next to non-existent unless one can pay. There would be no more nonsensical things such as giving more money to the health service in one hand and then tying the other hand behind its back with recruitment freezes because it is spending too much money.  

These suggestions are very general practice focused, but I am sure every specialty would have their own ideas on what they would do if they were given a billion euro. For some, it might mean expanding access to advanced high-tech drugs, increasing theatre time, or enhancing patient flow from the emergency department through the hospital and back home.

I’m sure this Budget will be full of lots of lovely goodies targeted at nice middle-class people in the hopes of getting a first, second, or even third preference, be it in the form of energy credits, tax cuts, or the aforementioned free HRT.

Whatever they are, I just hope that the Budget’s decisions are made with a genuine aim to enhance health, housing, and infrastructure, rather than simply surviving the electoral count in some cold leisure centre hall this coming winter or spring.