The pre-budget submission by the Irish Medical Organisation (IMO) has said next month’s budget must mark the start of an era of substantial and ongoing funding for the health services.
The President of the IMO, Dr. Ina Kelly said that the goal must be to begin to build up the health services so that they will never again be as vulnerable in the face of a national health emergency as they have been through Covid 19.
Dr. Kelly said that the health services were facing challenges “across the board’ and called for significant investment in Medical Manpower, Bed Capacity, General Practice, Mental Health Services.
Dr. Kelly said that while the services have received substantial financial support during the pandemic, the need for such support was largely due to decades of underinvestment; “the fragility of our health services was exposed during the pandemic and had it not been for exceptional efforts of Doctors, and other professionals across the country and huge temporary financial support, the services may have collapsed entirely. As it is, the services have been severely weakened and patients are being forced on to ever lengthening waiting lists which should shame a leading EU State.”
Dr. Kelly said that the lesson of the pandemic was the need to maintain investment in health on an ongoing basis and address the backlogs as a matter of urgency, so that you have maximum flexibility to respond to a crisis.
The IMO submission identifies seven key areas for the forthcoming budget.
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Invest in Medical Manpower
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- Immediately reverse the discriminatory and universal 30% pay cut imposed on new consultants to the HSE since 2012;
- Negotiate with the IMO for a new fit for purpose consultant contract that recognises the value of our newly qualified hospital consultants;
- Increase in the number of specialist training posts to meet current and future population needs. This measure will also support compliance with the EWTD;
- Modernise specialist training and career pathways in line with the recommendations of the Strategic Review of Medical Training and Career Structure (MacCraith) Reports 2014;
- Provide a reasonable and fair pathway for international doctors to access Speciality training;
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Invest in Acute Bed Capacity and Diagnostic Infrastructure
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- Resource a multi-annual programme of investment in acute bed capacity to include:
- 5,000 additional public acute bed capacity including
- investment in stand-alone public hospitals for elective care and
- a doubling of critical care capacity to 550 critical care beds.
- Urgently assess and resource diagnostic, radiology, and laboratory requirements to ensure timely access to investigations and results for both hospital doctors and GPs in the community.
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Invest in General Practice and
the Shift of Care to the Community
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- Invest in supports for general practice to employ additional GPs, practice nurses and other support staff;
- Provide incentives for General practice to invest in the development of infrastructure including premises, medical equipment, diagnostic equipment, IT (as per the recommendations in the Indecon report);
- Given the precarious financial position of newly established practices - agree supports to allow these practices remain financially viable and open to patients;
- Invest in a comprehensive Women’s’ Health Programme in General Practice to include:
- Advice on Contraception
- Access to contraception including Long Acting Reversible Contraceptive (LARC) methods.
- Advice on sexually transmitted infection (STI), screening and testing for STIs
- Advice on fertility and pre-conception
- Advice on menopause
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Invest in Mental Health Services
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- Invest in a clinical programme of care for mental health care in General Practice to be negotiated between the IMO, the Dept of Health, and the HSE.
- Invest in publicly funded counselling and psychotherapy services and supports in the community, accessible on GP referral; - many practices have available rooms, which could facilitate these services and would de-fragment the management of mental health conditions.
- Fully resource community and hospital based mental health care teams in line with the recommendations of A Vision for Change;
- Urgently assess the number of acute inpatient psychiatric beds required to ensure timely admission of patients presenting with acute psychiatric illness;
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Invest in eHealth and
IT infrastructure
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- Invest in secure systems of electronic health records across hospitals and community health centres (systems must be able to communicate and allow embedding of national summary patient records).
- Upgrade IT infrastructure, both hardware and software, to improve cybersecurity to support safe remote-consultations and remote multi-disciplinary team-working.
- Ensure on-going investment and cooperation in the development of eHealth in General Practice in line with the agreement between the IMO, the HSE and the Dept of Health.
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Invest in Health and Social Needs for Older People
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- Further resourcing of rehabilitative community care beds and home care supports including intensive home care packages to allow older people remain at home as long as possible;
- Ongoing investment in a holistic approach to care with input from a range of specialties including geriatricians, GPs and public health specialists;
- Invest in a programme of GP care for nursing home patients that reflects the complexity of care required.
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Appropriately Resource Prevention Programmes
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- Increase Community medical staffing levels to maintain the quality and safety of child health and immunisation programmes, now that schools have reopened;
- Provide appropriate resources for the full re-establishment of life-saving cancer -screening programmes.
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