Let’s try even harder to cheer ourselves up this week by averting our gaze from NHS reforms and looking at a near neighbour with more pressing healthcare dilemmas. Not to mention deeper budget gloom. No prizes for guessing I was in Dublin recently.
As you may dimly be aware, the Irish are having an early general election next week, triggered by the budget crisis and collapse in confidence in the Fianna Fáil government which has ruled since 1998 and for most of the 20th century.
All you need to know is that even Fianna Fáil ministers openly acknowledge that it’s going to be thrashed and that rival Fine Gael, the socially conservative, middle class party, will win and form a coalition (their sixth) with Labour.
With their banking and housing debt crisis far worse than our own (they built more houses than they need, “ghost estates”, and guaranteed all the debts of foolish Irish banks that funded the property boom), you’d think that healthcare reform would not be a priority in 2011. After all, it has improved - and patient satisfaction is around 90 per cent.
But it is. Costs have risen sharply from 8 per cent of GDP in 2005 to around 12 per cent today, 15 per cent if you include social care for an ageing population.
Wards are being closed, waiting lists which shrank are growing. It costs €100 (£90) for an A&E hospital visit without a GP’s referral, but up to €60 to see the GP unless you are poor, chronically ill or old and have an exemption card. There are cuts everywhere, not least in pay, down 20 per cent in parts of the public sector, as charges rise, even for the over-70s.
Scary. But dipping into someone else’s health debate is to encounter similar problems, similar jargon about “protecting frontline services” and “cutting bureaucratic waste” before realising that they are not starting from the same place: their history is different.
Put simply, Ireland has a two-tier system, 80 per cent tax funded but with a significant top tier of private insurance which gets the better off into hospital faster: almost half of Irish people have insurance which is now (expensively) tax deductible. They have a lot of private hospitals too, underused but part of the boom which, as elsewhere, collapsed in late 2008.
In 2005, old health boards were consolidated into a national, arm’s-length health service executive, which manages the system, runs some hospitals directly and is poorly regarded. Labour, whose research based and costed reform plans are the most ambitious, would devolve management responsibility to local trusts, cutting 7,000 HSE staff in the process, and restore budget responsibility to the health minister.
It also wants a universal primary care insurance - as well, eventually, as one to cover hospital care - to be compulsory for the republic’s 4.5 million citizens. This would be provided either by the state or private firms, one of which, VHI, is actually state owned. It wants more - and fairer - competition between both purchasers and providers.
As in much else the outsider recognises here attitudes shared with British Labour modernisers, including a welcome admission that free GP access will all cost more, but keeping folk out of hospital will be cheaper. Greater efficiency, lower drug costs (only 13 per cent are generics, compared with 50 per cent in Britain) and curbs on GP and consultant salaries/private practice will help pay for it.
Sounds familiar? Yep. Fine Gael, whose likely health minister is a medic, would proceed more slowly. Fianna Fáil would expand private insurance and Sinn Fein - you’ll love this bit - seems to want to adopt the UK model. Don’t hold your breath.