Oireachtas Committee on Future of Healthcare Report

IMO says report fails to offer realistic and workable solutions to address the current problems in the health services 

Key Responses from IMO:

•             Proposal to introduce free GP Care to the whole population over 5 years is NOT achievable given current problems of capacity and funding in General Practice

•             Startling that the report does NOT recommend significant increases in bed numbers and instead offers unworkable and simplistic solutions to the capacity problem.

•             Report failures to prioritise recruitment of Consultants to tackle chronic shortage across the system.

Quote from President of IMO, Dr. Ann Hogan:

“The report contains many useful proposals but its credibility is seriously undermined by a failure to recommend realistic funding in respect of many of the principles of the Report.”

Tuesday 30th May 2017.  The Irish Medical Organisation (IMO) has given a mixed review to the Report of the Oireachtas Committee on the Future of Healthcare published today.  While acknowledging the work of the Future Healthcare Committee members, the IMO fear that the aspirational nature of the report fails to tackle the very real problems within our health services and grounds many of its proposals on simple and flawed assumptions.

Dr Ann Hogan, President of the IMO said that the report contained many useful proposals but that its credibility was seriously undermined by a failure to recommend realistic funding in respect of many of the principles of the Report. 

Speaking today Dr Hogan said “We can all agree that healthcare should be delivered on the basis of need rather than ability to pay and that, in an ideal world, such a system would provide all care on a universal basis which is free at the point of access.  However we do not believe this report will in fact deliver upon that goal given the wholly inadequate funding and capacity recommendations. In particular the failure to sufficiently and credibly address the capacity issue across the services both in terms of staffing and infrastructure is a major flaw.  Unless and until we have the basic elements required to deliver a functioning health service in place in the short term we cannot seriously commit or even aspire to delivering a universal system in either the medium or long term.”

Dr Hogan said “the overriding objective of each and every doctor in our health services is to deliver the best possible care to each and every patient.  We, along with our colleagues in the health services, are charged with delivering that care and it is our duty to advocate for change that will make a real difference to patient outcomes and to the development of our public health service.” 

The IMO has particular concerns in the following key areas:

•             Introducing  GP Care to the whole population over 5 Years is NOT achievable given the current problems with capacity and funding in General Practice

While the principle of a universal GP care system which is free at the point of access is laudable and the IMO agrees that any extension should be on the basis of income rather than age, the measures as proposed in the Report are simply not possible.   The current problems of capacity and lack of funding in General Practice makes this proposal unachievable in the short to medium term.  Such a measure cannot and should not be considered until General Practice is stabilised and has sufficient resources to deliver a full range of GP services to the current GMS population including Chronic Disease management.  The premise that the Report makes in terms of visitation rates are not evidence based and it can be accurately predicted that the number of visits will double on the introduction of universal care. Additionally the Report takes no account of the ageing patient profile which in and of itself will increase visitation rates.  The recommendation as detailed in the Report will increase the workload in General Practice in an unsustainable manner and if implemented will lead to fewer applicants for GMS lists, reduction in services to patients around the country and further exacerbate the trend of emigration of our younger GPs.  These proposals will not increase access for patients but will instead ensure the exact opposite will be achieved given that the General Practice is already operating at the limit of its capacity. 

•             Ceasing to provide private care in public hospitals will NOT address the capacity problem

The proposal to end the provision of care to private patients in public hospitals as a means of increasing capacity in our public hospitals demonstrate a fundamental misunderstanding of the operation of the hospital system.  There is no evidence backed assessment of how this measure would increase capacity in our public hospitals nor any analysis of the impact of the loss of indirect co-payments on budgets in public hospitals, payments on which hospitals rely upon to deliver services to all patients.  This proposal fails to recognise the right of all citizens to avail of publicly funded services, regardless of whether or not they hold private health insurance and what affect such a measure will have if there is any significant trend among the population to cancel private health cover.  Given the drastic cuts to the number of acute hospital beds over the past decade (1600 beds), coupled with an ageing population that requires complex health interventions, it is startling that the Report does not recommend significant increases in bed numbers and instead offers unworkable and simplistic solution to the capacity problem, the result of which will be continued ED overcrowding, hospitals operating a dangerous capacity levels, cancelled operations and longer waiting lists.

•             The number of additional consultants (593 from Year 4) recommended by the Report will NOT deliver a consultant delivered service to patients

Medical evidence supports a consultant delivered service so as to deliver the best care to patients and improve overall health outcomes for the population.  The current level of consultant manpower in Ireland falls well short of the OECD average and additionally the National Task Force on Medical Staffing recommends that we need in the region of 2000 additional consultants to treat the current patient profile and with further numbers required as the population ages..  While we welcome the acknowledgement in the Report that there is a recruitment and retention problem in Irish medicine and that improved working conditions will be required to attract and retain high quality professionals there also needs to be a recommendation that this be addressed as a priority so that we have the medical workforce in place to implement a consultant delivered service,  the type of service that our patients need, they have paid for, and they deserve.    

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