Fianna Fáil believes in a strong public health system where the impact of public funding is maximised, and where services are as close to people as is consistent with quality care.
We believe a taxation-funded health system is more progressive as it allows the government more control over the overall health care bill. It also prioritises health care for the most vulnerable and those who cannot afford to pay towards their care.
We believe in a complementary private health care system as this gives people who can afford private health insurance a choice while subsidising the public health care system through tax.
By contrast, a system of universal health insurance (UHI) with multiple purchasers of care means the government surrendering some control over the overall level of resources devoted to health.
The maintenance of a tax-funded system, controlled by the government, would have a number of benefits over a multi-purchaser, insurance-based system.
There is simply insufficient evidence from international systems to suggest that a change in the funding mechanism would produce benefits sufficient to justify the disruption that such a change would cause, and indeed there is some evidence to suggest that such a move would lead to higher costs for the Irish public without significant improvements in health outcomes.
The Dutch system, on which Fine Gael base its proposals, introduced universal private health insurance with managed competition in 2006. In the Netherlands health care spending per capita increased by 46% between 2005 and 2010.
Furthermore a family with a combined income of under €50,000 a year was paying almost €11,500 in health costs in 2012, or 23.5 per cent of income, according to the analysis by the Dutch Health Performance Report for its government.
The fact is that if you take something that is now voluntary, health insurance, and make it compulsory there will be huge additional costs.
Fianna Fáil will not send the Irish health system down that road.
For our health service, I believe that we must give primacy to primary care. We see it as the bedrock of care provision providing as it does an all-encompassing point of access.
Robust and active primary care is seen as playing an essential role in enhancing health outcomes and limiting costs.
It is through primary care that we should look to meet 90-95% of all health and personal social service needs.
A robust primary care system will be crucial for preventing the development of conditions that could ultimately require acute hospital care.
A strong primary care system will also provide the right environment to enable earlier discharges from hospital and stop the scandal of the delayed discharges.
So we must rebalance the health budget towards primary care.
Now it can be difficult to quantify exactly what proportion of our health spending goes to primary care.
Depending on which HSE plan you’re looking at it can go from 3 to 5 to 6 per cent of the health budget.
For 2015 the Service Plan committed to €726 million in Primary Care but again the HSE’s Primary Care Division – Operational Plan 2015 indicated a specific Primary Care budget of €611 million.
Nonetheless whichever figure is used primary care expenditure in Ireland is low by international standards where there is an accepted benchmark of around 10 per cent of health expenditure.
For example in the UK in 2004-05, 10.33% of the NHS budget was spent on general practice. This figure has since declined to 8.4 per cent which is causing concern and there are calls for it to increase to 11 per cent.
Fianna Fáil believes that if we are to make primary care the bedrock of our healthcare system we must make gradually rebalance the proportion of our health budget going to primary care to that international benchmark of 10 per cent.
And at the heart of primary care must be the family GP.
Fianna Fáil values our family doctors, appreciates the work they do and believes that GP services must be properly resourced.
We also believe that we need more of them.
There is great anger amongst GPs at their treatment by government, anger we believe to be justified and legitimate.
We believes family doctors when they assert that many GP practices are now running at unsustainable levels of net income after meeting unavoidable practice costs.
It has been estimated that around one in 12 practices are under financial risk of closing.
There are a number of areas across the country, both rural and urban where there is no GP cover, where no self-employed contractors are available to operate as GPs.
This cannot continue and we will address this. If necessary, Fianna Fáil will direct that GP’s be directly employed on a salary by the HSE.
Now I accept that there has been much talk of developing primary care over the past decade and a half.
While some progress has been made it falls way short on what really needs to be done.
So in government we would bring forward a clear plan to make this transformation over a set time.
There will need to be a budget for reform. A recent report commissioned but not yet published by the HSE made the point that in debates about reform the costs of implementing reforms are never estimated.
We will ensure that any reform is accompanied by a budget. This may cost in the short term but reform cannot be funded from existing budgets for services that will continue to be needed while primary care is developed.
Every year there will be a specific plan with regular progress reports.
The plan will set targets for the number of GP and other necessary staff.
It will also outline the expansion and assignment of services into primary care that currently take place in hospitals.
As for our hospitals, our reforms will ease the pressure on them. But I don’t pretend for one moment that an advanced primary care system will of itself stop emergency department overcrowding. After all if it is deemed appropriate to admit someone to a hospital bed then clearly they should be in hospital.
And while it’s not just a question of resources, clearly resources and more of them are part of the answer for our emergency departments.
Resources and our management of them will by key in the future. I want us to move on from the chaos of an a budget being published one year and the Minister for Health arriving in every December with a supplementary estimate.
And if the Minister’s comments to me in the Dáil on Wednesday about “bringing forward a spending plan later in the year” are accurate there’ll be another supplementary this year too.
We know health needs more resources. With an ageing population you need more resources simply to stand still. It’s time to provide them.
Now let me turn to the HSE. It has its critics. I’d say many of them are here today. And if its Director General was here today, he’d probably tell you that I’m one of the critics too.
But let me say this. The HSE is just ten years old and its thousands of workers deliver care in every community and in a wide range of facilities.
It is gradually ending the fragmentation of policy and delivery in vital services. And that’s why we set it up.
Let’s be clear. It has supported and enabled the development of new services on a national and regional basis which are already dramatically improving patient outcomes.
We established the HSE because we wanted to bring clarity of roles and accountability — political responsibility for the Minister and management responsibility for the management.
Fianna Fáil will not be abolishing the Health Service Executive as there needs to be equal implementation of health policy across the country.
We might examine renaming it so as to give greater emphasis to the Service as opposed to the Executive but a national health service broadly funded from general taxation is intrinsic to our health policy.
These for me are the fundamentals. A strong public health system, funded by taxation with quality services as close to people as is possible.