Budget 2020 must begin to address serious deficits in healthcare

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Healthcare services are fundamental to wellbeing - important in themselves and important to economic success in a range of ways, including improving work participation and productivity. Securing healthcare services and infrastructure is a key policy area that must be addressed urgently as part of Budget 2020.

People should be assured of the required treatment and care in their times of illness or vulnerability. The standard of care is dependent to a great degree on the resources made available, which in turn are dependent on the expectations of society. The obligation to provide healthcare as a social right rests on all people. In a democratic society this obligation is transferred through the taxation and insurance systems to government and other bodies that assume or contract this responsibility.

One of the most obvious concerns about the Irish healthcare system is to do with access. Ireland ranked 21st out of 35 countries in 2016 in a report by Health Consumer Powerhouse published in 2017, but on the issue of accessibility, Ireland ranked among the three worst countries. That  report notes that even if the (then) Irish waiting-list target of 18 months were reached, it would still be the worst waiting time situation in Europe. Irish hospitals are working near full capacity. The occupancy rate for acute care beds is among the highest in OECD countries, and while having a high utilisation rate of hospital beds can be a sign of hospital efficiency it can also mean that too many patients are treated at the secondary care level.

Our complex two-tier system for access to public hospital care means that private patients have speedier access to both diagnostics and treatment, while those in the public system can spend lengthy periods waiting for a first appointment with a specialist and for treatment. National Treatment Purchase Fund figures suggest that 70,295 people were waiting for treatment as an in-patient or day case at the end of April 2019, a situation that had worsened since December 2014 (when it was just above 63,000).

There is a need to focus on health and social care provision for children and families in tandem with the development of primary care networks and a universal approach to access to healthcare. In 2016 the United Nations Committee on the Rights of the Child voiced concerns about children’s health in Ireland, including concern about the state of health of children in single-parent families, children in poverty, and Traveller and Roma children.

Government needs to urgently address these inequalities in the health service and implement a programme that provides access on the basis of need.

Proposal: To address the inequalities in our healthcare system and develop a system that is fit for purpose for all, Government should:

• Invest the €500m infrastructure allocation set out in Sláintecare.
• Invest €50m in Community Nursing Facilities.
• Invest €150m in the roll-out of primary care networks to alleviate pressure on acute services and ensure treatment is provided at the appropriate level of need.
• Dedicate €75m to an anti-obesity programme.

Specific supports should also be implemented for people experiencing mental health difficulties and dual diagnoses of mental health and addiction issues. 

Problems with mental health can arise at any age; however young people are especially susceptible and early intervention is key.  The  aforementioned UN Report also raised  concerns about children’s mental health services, including children being admitted to adult psychiatric wards, long waiting lists for access to mental health support, and insufficient out-of-hours services for children and adolescents with mental health needs, particularly eating disorders. The report also expressed concern about the high number of suicides among adolescents and stated that Ireland should adopt all-inclusive legislation that addresses the health needs of children.

Proposal: Invest in the full implementation of the Vision for Change policy at a cost of €35m and increase funding for programmes dealing with alcoholism and addictions at a cost of €50m.