Health service plans may become an expensive failure, warns IMPACT

IMPACT today (Wednesday) cautioned health minister James Reilly that Government plans to introduce universal health insurance and hospital clusters run by trusts could become expensive failures if lessons from abroad are ignored.

Responding to the minister’s speech at an IMPACT symposium on the future of Irish health services, IMPACT national secretary Louise O’Donnell said the Dutch model of universal health insurance, which is held up as a model for Ireland, had resulted in a “three-tier system” where almost half a million people were uninsured or defaulting on insurance payments while the wealthy supplemented compulsory cover with additional private insurance. She said the system had increased bureaucracy and that more than half of Dutch hospitals, which depend on funding from universal health insurance, faced bankruptcy last year. Others had closed.

Ms O’Donnell added that the cost of health insurance in Holland had risen steeply since the compulsory system was introduced in 2006 with a basic package now priced at up to 10.7% of household income. “It is hard to see how Irish families will bear this kind of additional cost, or where the Government will find political support for it,” she said.

On the day that the Government confirmed that the Croke Park agreement had delivered health service savings of over €400 million in its first two years, Ms O’Donnell said health staff were willing and able to deliver more reforms even as budgets and staff numbers continue to fall.

“But after the experience of the HSE, I believe the Government faces a major challenge to convince staff and the wider public that its change proposals really hold out the prospect of improved health services. That is a challenge in terms of the substance of the proposals and in terms of reaching out to communicate with, and involve staff in, delivering effective change. Scepticism, even cynicism, thrives when massive upheaval fails to deliver obvious benefits to patients and other service users. Health workers and service users face confusion over planned health service structures and delivery in the absence of a cohesive strategy for what will follow the planned abolition of the HSE,” she said.

Ms O’Donnell said IMPACT supported the objective of a universal health system, based on equal access for all, which was “long overdue and very much to be welcomed.” She said the union would also support the clustering of hospitals into groups if it genuinely delivered more and better services to patients. “But IMPACT has many concerns over the detail of how these ambitions are to be realised, particularly in the current spending climate. And we have many questions about the funding models currently under consideration by the Government,” she said.

“The one key ingredient for any successful change management strategy is information, upfront and available to all the stakeholders. There is a mammoth task facing us but it can be achieved if there is openness and transparency about what we are trying to achieve and clarity about the final outcome and the services it will deliver,” said O’Donnell.

Today’s symposium also featured contributions from the HSE’s director of Quality and Patient Safety, Dr Philip Crowley, INMO general secretary Liam Doran, Christina McAnea of the British union Unison, and independent researcher and policy advisor Dr Jane Pillinger. The event was the start of a consultation and research process which will result in a new IMPACT policy on health service reform later this year.

IMPACT is Ireland’s largest public service trade union, which includes 30,000 health workers among its 63,000 members. They work in a wide range of professions and occupations including health and social care professionals, administrative and management grades and technical staff.