In terms of the range, imagination and costedness of progressive health policies, Sinn Féin is in front, though Fianna Fáil’s is scrupulously budgeted for and the Social Democrats’ most orthodox.
By Michael Smith
All of Ireland’s political parties have signed up to Sláintecare which should be implemented by the end of 2028.
That’s the key background to their manifestos which show variations and detail on what is now the template.
Apart from Solidarity which has an appealingly short health manifesto including secularisation of hospitals and nationalisation of all private health and pharmaceutical enterprises, differences in policy are therefore largely about how the parties would prioritise elements of Sláintecare.
Though in fact Sláintecare does itself lay out a timetabling of priorities. This means there is an anomaly between many parties’ support for Sláintecare up to 2029 including its timetable, and budget; and their proposals of separate interim timetables and budgets during the next, five-year, term of government.
Presumably, if they frontload expenditure into the first five years when Sláintecare envisages a longer rollout, then there will be less expenditure in the second five years. Otherwise, the parties are implicitly disassociating from what they have all agreed as the central planks in their health policies.
Extra expenditure during the term of the next government will have to come from the €11bn ‘fiscal space’ over five years projected by the Department of Finance and accepted by most parties.
Beyond this, the parties have tacked on special pet projects. But these are likely to be compromised by coalition or partnership negotiations.
Past performance is something of a guide to future performance so it is worth looking at the history of parties, particularly Fine Gael and Fianna Fáil, in drawing and implementing health policy in the State.
Implementation of health policy will be largely determined by Sláintecare with the parties’ longstanding ideologies a guide, especially on immediate funding and their indulgence of some pet projects though not necessarily the ones listed in manifestos.
On Health Policy Village cautions caveat emptor; there is every possibility there will be little change.
This guide synopsises parties’ policies. If transposition results in any mistakes Village would be pleased to correct them.
Because there is such overlap the most instructive thing we can do is highlight original and different approaches, in bold.
History of Health policy in Ireland
In the second half of the 1940s, after it was instigated in the UK, a National Health Service was promoted by Fianna Fáil and even made it as far as a White Paper. But Ireland never got a single-tier health service, at first because of medical-profession lobbying supported by the Fine Gael Opposition, then because of-church opposition, and then because of medical-profession lobbying and revised Fianna Fáil ideology.
Donogh O’Malley, the hero of free secondary education, was against ‘socialised medicine’ when Minister for Health (1965-6): “those who could pay should pay”.
The two-tier, medical-card, system of access to hospital care is a construct of Fianna Fáil governments, albeit never seriously challenged by any other party in government.
With no vision for the health system, Fianna Fáil threw money at healthcare in the late 1970s only to cut back savagely in the late 1980s. Between 1986 and 1993 over a third (5500) of beds were cut nationally.
The health budget quadrupled from under €4 bn in 1998 to over €15bn in 2008, largely playing catchup after Haughey-era cuts; and to €17.8bn in 2020.
2000 beds were cut in 2009 under Fianna Fáil/Greens/PDs but Fine Gael have put back around 900 since 2011.
In the last government HSE staffing increased by 8,868 to 119,126 by the end of last year. HSE management/administration employees increased by 2,042, an extra 328 consultants were appointed and there were 2,008 more nurses, according to Department of Health figures.
Because of the shortage of hospital beds, the average hospital stay in Ireland at 6.2 days is much shorter than the OECD average of 8.2 days; and Ireland hospitalises far fewer patients, at 139 per 1,000 of the population annually, compared with an OECD average of 169.
Fianna Fáil, under Finance Minister Charlie McCreevy (1997-2004), gave generous tax breaks to developers to build private nursing homes and hospitals: although it was government policy to have fewer, bigger, safer acute hospitals, another arm of government was giving away public money to build small, profitable, unregulated hospitals anywhere they decided, totally contradicting the policy.
In 2001 it gave and in 2008 it took away, un-means-tested medical cards for over-70-year-olds, recently reinstated by Fine Gael, the government then had to negotiate a very bad deal with GPs who (led by James Reilly who later finished up as a bad Minister for Health) squeezed the pips. As a result, GPs were paid three times the rate for looking after richer over-70s than those who already had medical cards. This skewed GP services so that doctors were paid more to provide care to those who needed it least.
The establishment of the HSE is the biggest public-sector reform in Irish history. Prepared by Mícheál Martin but executed by Mary Harney it was badly planned, leaderless for its first seven months, without structures, a clear plan for redeployment of staff who’d been organised on a county level, or a vision specifically to provide universal, quality care.
There have been numerous attempts to reform but without any real transformation. The renegotiation of the consultants’ contract a decade ago was a lost and expensive opportunity at enormous expense to reform the Irish health system but it is only very recent and exorbitant proposals to pay €250,000 – twice what Britain’s NHS pays – to consultants to practise only publicly are something of a start.
A White Paper on Universal Health Insurance was published in 2014 with a report on the potential costs of the White Paper model published in November 2015. The debate was always too much about the cost of this rather than on how a focus on insurance might actually serve the presumed goal of universal healthcare. In the end, Leo Varadkar suspended it, likening universal health insurance to Irish Water. He claimed it would have been impossible to impose the extra fees without a backlash from struggling families. While denying the Coalition had performed a U-turn on its central health policy, he was unable to give any specific year as to when a new version will be introduced. He also appeared to criticise his predecessor James Reilly by alleging there had been an “obsession” with the Dutch form of UHI. Varadkar insisted the Coalition remains committed to introducing the policy at some unspecified stage in the future. In fact, the role of insurance has been eliminated in Sláintecare.
Then Minister for Health Leo Varadkar pledged at the 2011 election to bring an end to the hospital trolley crisis.
The 2011 Programme for Government pledged:
This Government is the first to commit to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income. By reforming our model of delivering healthcare, so that more care is delivered in the community, and introducing Universal Health Insurance, the aim is to reduce the cost of achieving the best health outcomes and end the unfair, unequal and inefficient two-tier health system…
A system of Universal Health Insurance (UHI) will be introduced by 2016…
Universal Primary Care will remove fees for GP care and will be introduced within this Government’s term of office under a Universal Primary Care Act.
It was all meaningless.
Cancer care is an illustration of where genuine progress has been made. A series of healthcare scandals propelled it to the top of the agenda. Cancer-care was moved from 30 to nine, safer, hospitals.
Ireland’s healthcare system overall ranks 22nd out of 35 countries, according to the European Health Consumer Index of 2018. It has the worst hospital waiting lists in Europe, and is bottom of the league for value for money. This is despite its favourable demography.
| Form of Health Cover (may overlap) | % of population |
| Medical Card | 37% |
| GP Visit Card | 3.5% |
| Private Health Insurance | 45% |
| No cover | 20% |
Sláintecare
Of course all parties have signed up to Sláintecare as anticipated under the Programme for Partnership Government 2016. Notably it has been underfunded and has moved little in the three years since settled by an all-party committee chaired by Róisín Shortall in May 2017. Funding is being provided annually rather than over Sláintecare’s envisaged timeframes. Tellingly, an ‘Implementation Office’ was not created until September 2018.
According to the Centre for Health Policy and Management in Trinity College Dublin, Sláintecare will provide:
• Entitlement for all Irish residents to all health and social care
• No charge to access GP, primary or hospital care and reduced charges for drugs
• Care provided at the lowest level of complexity, often outside of hospital, in an integrated way
• eHealth (i.e. internet or computer based health) as key tool for developing a universal health system and integrated care
• Strong focus on public health and health promotion
• Waiting times guarantees with a maximum:
• 4-hour wait time for Emergency Departments
• 10 days for a diagnostics test
• 10 weeks for an outpatient appointment
• 12 weeks for an inpatient procedure.
• Private care phased out of public hospitals
• Significant expansion of access to diagnostics in the community
• Earlier and better access to mental health services
• An expanded workforce including allied health professionals, nurses and doctors.
• A new HSE Board, to be established promptly
• Accountability and clinical governance to be legislated for
• A National Health Fund set up to ring-fence funding for a transitional fund and expansion of entitlements
The report sets out specific costings for the expansion of entitlements and system development and timelines for implementation, recommending the establishment of an Implementation Office to drive the reform.
The report is for a ten-year period but many of the key actions will be implemented during the first six years. This is roughly coincident with the term of the next government.
The expansion of entitlements detailed in the report will cost an additional €2.8bn by year ten, with a one-off transitional fund of €3 billion (keep your eye on that figure for comparisons) required over the first six years (roughly €500m annually over the term of the next government) for infrastructure investment, including renovations and new beds, expansion of training capacity and the timely implementation of the eHealth strategy; as well as for more staff across the range.
Sláintecare is costed at about €5.8 billion.
The parties have made little effort to clarify exactly which elements of Sláintecare they intend to vary, and how. It is part of the great joy of Irish elections that the media have not managed to make any progress in clarifying this. Fergal Bowers, RTÉ’s Health Correspondent writes, for example, that, “We see that Fine Gael is promising an extra €5 billion for health” https://www.rte.ie/news/election-2020/2020/0129/1111660-health-manifestos-bowers/. But it is clear from their manifesto that in fact Fine Gael is proposing that annually over five years. Clearly the figures are not like for like or over the same timeframes. It is not even clear the division of parties’ allocation between current and capital expenditure. RTÉ seems to be doing its audience a disservice by listing headline figures as if they were directly comparable.
• The Social Democrats are content just to implement Sláintecare as agreed
- Fine Gael – €5 billion annually after 2025
- Fianna Fáil – €2 billion annually more than existing allocations
- Sinn Féin – €4.5 billion for current and €1.5b billion for capital more than existing allocations
- Labour – €5 billion over 5 years
- Greens €5 billion over 5 years
Party policies
Fine Gael
Fine Gael doesn’t have much new to say as it is the incumbent and is clearly wedded to Sláintecare. Its policy is called ‘Implementing Sláintecare’.
It says it would spend an extra €5bn per year on health over the five years of the next government. This would be used to fund 2,600 extra hospital beds; 4,500 community beds; 5,000 extra nurses; 80 additional primary care centres and diagnostic centres; elective hospitals in Dublin, Cork and Galway and 3,840 primary care workers.
Daily hospital car parking charges would be capped at €10.
Free GP care would be extended to everyone under the age of 18, the income limits for medical and GP visit cards would rise, and the threshold for medical cards for the over 70s will go back to 2012 levels.
Fianna Fáil
Fianna Fáil would spend an extra €2bn on health and claims that Fine Gael’s €5bn promise includes pre-existing commitments and is skewed because of changing demographics which obviously require more expenditure every year. It is allocating €1.8 billion of the €11 billion ‘fiscal space’ to allow for this. Its budgeting is impressive with each additional head of expenditure costed.
Fianna Fáil’s figure seems conservative since health-cost insurance and demographic – including population increase and population ageing – reasons suggest that figure would struggle to maintain current standards which are of course disgraceful.
It is implicit that Fianna Fáil would make efficiency savings but unimpressively they have failed to say where. It does aim to “Improve Management & budgetary accountability” and “put in place an Office for Budget Responsibility in the Department of Health to oversee health spending and ensure reliable forecasts”. It also proposes to enhance management practices to ensure accountability and ensure medical profession cooperate with corporate governance policy.
There is much fat around the HSE and scope to reduce professional fees. It would target increased numbers to decrease the overreliance on agency staff. Asked where savings could be made in the health service, its Health spokesperson Donnelly said the “big opportunity” arose from the planned move to new regional structures. He criticised the Government for not collecting adequate data to enable this question to be answered.
It proposes to recruit at least 800-1000 extra consultants over five years. Asked whether he supported the Government’s offer of €250,000 salaries to consultants who agree to public-only contracts, Fianna Fáil’s Health spokesperson Stephen Donnelly said Fianna Fáil proposes to negotiate a new contract with consultants as the contract deal has not been finalised. He later clarified Fianna Fáil “don’t want to see any private work in public hospitals” but this will take time to do and will be expensive.
It proposes to end pay inequality for post 2012 entrant consultants.
Fianna Fáil wants an extra 2,600 hospital beds; to reduce emergency department waiting times to four hours. It aims to provide an additional 20 emergency ambulances and 200 extra staff.
It proposes to double funding to the National Treatment Purchase fund to €200m and ensure that anyone waiting more than six months for a procedure will be able to apply to the fund; recruit 4,000 extra nurses; expand free GP care on the basis of means in line with Sláintecare’s goals and in alignment with an expansion in capacity.
This appears to be a regression to Fianna Fáil’s deference to the market, as it promotes private consultants systematically dealing with public patients, paid for by the state. Fianna Fáil, with the Progressive Democrats, was the author of the dead-end co-location policy which envisaged private medical facilities on public-hospital grounds. Unravelling that policy has diverted a great deal of energy over the last generation.
It would implement the recently agreed changes to the GP contract and include provisions for its continuous assessment and improvement.
It proposes to increase home-care hours by five million over a term of office; increase funding to the Fair Deal nursing-home scheme by €225m.
It would implement the new regional structures proposed under Sláintecare.
It proposes that those experiencing financial hardship due to very serious illnesses such as cancer will receive a discretionary medical card.
It proposes to abolish prescription charges on a phased basis.
It would restore confidence in the Screening Services
It proposes to issue National Planning regulations to create “No Fry” zones for new Primary and secondary schools.
It aims to make Ireland a tobacco free society. It is on track for a 5 per cent rate by 2030.
It proposes to increase funding to drugs taskforces by €3m annually over the next two years and then review the situation further.
Social Democrats
The Social Democrats essentially support Sláintecare, which is partly the brainchild of its expert health spokesperson, Róisín Shortall.
The Social Democrats believe the current Irish health service is far too dependent on hospitals, and much of the care could take place in local health centres instead – resulting in reduced costs and improved efficiency.
It considers the Irish system is currently an illness system rather than a functioning health service. The party intends to frame a revamped system around their Sláintecare proposals which set out a road-map to move from a crisis-driven approach to one that focuses instead on community care, prevention, and equal access for all and includes:
· Free health services in our communities;
· Quicker access to public hospitals;
· Community care teams for older people and those with mental health needs;
· Diagnostics like x-rays and scans provided locally;
· Thousands more doctors, nurses, speech therapists, and public health nurses.
· An increase in hospital bed capacity and an end to the trolley crisis.
The Social Democrats say that when Sláintecare is implemented, Ireland will finally have a health system that is comparable to other European countries, based on need and not on ability to pay.
Labour
Labour like everyone else is committed to ending the two-tier health system.
In Government, it emphasises, Labour delivered 90 new primary care centres, commenced work on 73 more, and introduced free GP care for the under 6s and over 70s.
Their plan for the next five years:
Extend free GP care to those under 18, followed by the rest of the population to ensure no-one has to pay to see their GP by 2021 at the latest
Reduce drug costs and prescription charges
Introduce a universal entitlement to a free dental examination, scale and polish twice per year
Recruit 1,426 new full-time GPs and introduce a GP rural scheme to ensure nationwide coverage
Roll out community-based programmes targeting the most prevalent chronic diseases in the community
Bring in a Minor Ailments Scheme to allow free-of-charge treatments for common illnesses at local community pharmacies
People Before Profit (PBP
PBP proposes a National Health Service that treats people according to medical need. It wants to:
Establish an Independent Health Promotion Agency to promote health and preventative behaviour.
Abolish the HSE – hospital groups and CHOs to be integrated and governed by new health councils.
Create a network of community primary care centres – free GP care for all.
Guarantee access to health care within 18 weeks.
Guarantee access to emergency hospital care within 4 hours of presenting to an Emergency Department, elective hospital inpatient care within 12 weeks of referral, outpatient care within 10 weeks and diagnostic procedures within 10 days.
Move to 21,000 beds nationally to increase capacity. Compulsory purchase of private facilities required as part of increasing the number of public beds.
Increase ambulances and air ambulances to meet 8-minute response times. Introduce a Paramedic Transport Service
Increase medical technicians by 750 as per HIQA recommendations
Re-open hospitals closed during the recession including emergency departments.
End ‘outsourcing’ of frontline health service jobs
End outsourcing of non-medical healthcare staff
Stop all support and tax breaks for private hospitals and health care facilities
Reduce profiteering by private drug companies. move to a National Pharmaceutical Company.
Abolish prescription charges and all other out-of-pocket payments such as hospital in patient charges; abolish car parking charges in hospitals – reduce the drug payment scheme threshold to zero.
Establish 500 primary care teams and primary care centres to house them.
Invest in a network of Community Development Health Workers based in community projects.
End the ‘Fair Deal Scheme’ and improve funding for the elderly.
Increase funding for Mental Health and ringfence funding for child and adolescent mental health.
Disability services should follow a rights-based approach.
Increase Personal Assistant Hours so people with disabilities can lead independent lives.
Early intervention for children with disabilities.
Improve age appropriate services for young people.
Improve cancer care including screening, access to diagnostic tests, radiotherapy/chemo.
Extend diagnostic option during pregnancy in weeks 18-22 to all who want them.
Extra support for those with autism and those with dementia. Transgender people to access services as a fundamental human right.
Create fresh fruit clubs and comm
Unity exercise initiatives.
Chemicals added to food, water or air should be more closely regulated and subject to public consultation and control
Create a country wide network of cycle lanes
End Corruption and Improve Service Planning.
Investigate malpractice at Midland Regional Hospital Portlaoise
Build resistance to cuts and privatisation in healthcare.
Work in con-junction with the Still Waiting Health Campaign to unite trade unions, workers and service-users to fight for a better health service for all.
Solidarity
End the unjust, two-tier health service. For a public, secular national health service free at the point of use. Nationalise all privately owned hospitals and pharmaceutical companies.
Greens
The Green Party believes in a single-tier health system, funded by general taxation, that gives universal access based on patient need.
Cut hospital waiting times
Boost primary care facilities
Use 24-hour online/phone service directing patients to appropriate care
Delegate more to paramedics and advanced nurse practitioners
They’re in favour of dissolving the HSE and replacing it with Community Healthcare Organisations (CMOs) to reduce hospital waiting times. Less pressure on emergency departments means you get medical attention quickly if your need is serious…but you don’t have to go to A&E for minor ailments that can be treated in primary care centres.
Empower the patient
Place you at the centre of your healthcare
Give you access to your records
Own up to mistakes
You should be the one making decisions about your healthcare…with medical staff supporting you through your treatment options.
They support an eHealth strategy that gives patients access to their summary care reports…and when something goes wrong, they favour ‘No-fault’ compensation, followed by investigation.
Support the Carers
Community Respite Centres for carers of people with disability
Disability assessments within three months
Inclusion of mental health in the Long Term Illness Strategy
If you suffer from long-term illness—or care for someone who does—you deserve support. The Green Party’s disability policy recognises that services and supports should be made available to allow people of all ability to live life as fully as possible.
Invest in Prevention
Encourage healthy lifestyles
Appoint school nurses
Get tough on alcohol and tobacco promotion
The Green Party believes health education plays a vital role in health policy.
Sinn Féin
Sinn Féin will increase the health budget each year by the following amounts cumulatively:
| Year | Amount |
| Year 1 | €794 million |
| Year 2 | €771 million |
| Year 3 | €614 million |
| Year 4 | €584 million |
| Year 5 | €518 million |
Sinn Féin in government would:
Increase spending by an additional €4.5 billion for Current and €1.58 billion for Capital spending in our health service over and above what has already been committed for the period including for demographics.
Sinn Féin Priorities
» Lifting the Government’s recruitment freeze and hiring more nurses, doctors, and healthcare staff
» Opening more hospital beds
» Increasing funding for the home-help scheme to deliver for all older people
» Beginning the implementation of Sláintecare
» Rolling out free GP care
» Providing medical cards to cancer patients
» Abolishing prescription charges
» Fully staffing all Primary Care Centres
» Delivering dental care for under 18s
» Ensuring a state-sponsored contraception scheme for women
» Ensuring fair, transparent and regionally balanced healthcare planning
» Reducing food waste in our hospitals and introduce mandatory food standards
» Delivering free hospital car parking
Health service staff
Sinn Féin’s priorities:
» Recruit 2,500 more nurses and midwives at a cost of €134 million
» Hire 1,000 more consultant doctors – consultants and NCHDS at a cost of €224 million
» Pay restoration for new-entrant consultants and a new consultant contract
» Convert agency staff into directly employed HSE staff
» Full reimbursement of examination costs for all Non-Consultant Hospital Doctors
Primary care
Sinn Féin’s priorities:
» Deliver free GP care for all over a term of Government at a cost of over €455 million commencing with two free visits for everybody that is not covered by a medical or GP visit card in year one
» Phased increase in the threshold for GP visit cards on road to free GP care
» Negotiating a new GP contract
» Increasing the number of GPs training scheme places at a cost of €25 million
» Directly employing 500 HSE GPs at a cost of €82.5 million
» Hiring 1,500 additional new staff for Primary Care Centres
» Employing 1,000 more practice, community care and public health nurses at a cost of €58.8 million
» Bursary for GPs making the move to practice in Ireland
» Ensure primary care encompasses social care and mental health
» Commence negotiations on a new pharmacy contracts and expand role of community pharmacy
Removing taxes on ill-health
Sinn Féin’s priorities:
» Abolish prescription charges and roll-out free prescription medicines for all at a cost of €330 million
» Abolish the charge for the use of Emergency Departments and the per day charge for inpatient care at a cost of €48 million
» Remove hospital car parking charges at a cost of €22.4 million
» Medical Cards for all cancer patients
» Increase income thresholds for the medical card
Home Care
Sinn Féin’s priorities:
» Introduce a statutory home-care scheme
» Increasing the role of the public and not-for-profit sector in the provision of home supports
» Deliver an additional 12 million home help hours over five years to meet growing and unmet need at an annual cost of €59 million
» Increasing step-down facilities
» Increasing the number of nursing home beds by 1,250 over term of Government
Hospital bed numbers
Sinn Féin’s priorities:
» Investing an extra €1 billion of capital and €480 million of current spending to increase the number of hospital beds by 1,500 over our first term of Government and then invest further bring up to 2,500 in subsequent term
» Recruiting the additional nurses, doctor and other health professionals necessary for the operation of these additional beds
» Making better use of the existing bed stock
» Stopping the continuous breach of safe levels of bed occupancy
» Increasing exit packages, home help and home care » Increase nursing home beds by 1,250
The hospital waiting list crisis
Sinn Féin’s priorities:
» Implement a new waiting list management system
» E-Health
» Establish elective only hospitals
» Increase the number of beds in our hospitals by 1,500 over first term of Government and employ the doctors, nurses and other professionals necessary for the operation of these beds
Women’s health
Sinn Féin’s priorities:
» Funding and implementing the National Maternity Strategy with an additional €75 million
» A greater focus on care and diagnosis for cardiovascular disease in women
» Education and awareness programmes for breast and cervical cancer and the repatriation of screening services
» Free contraceptives, in all forms, and emergency contraception
» Enacting safe access zones
» Free provision of female hygiene products for students, those in DP, those in emergency accommodation, and those with a medical card
» Three full cycles of IVF for all qualifying couples
» Effective and compassionate care to women from ethnic and other minority backgrounds, such as lesbian women, migrant women, Traveller women, Roma women, and others
» Establishing dedicated healthcare pathways for women suffering from mesh complications
» Implementing the recommendations made in the Scally, MacCraith and RCOG Reports, with oversight from the Cervical Check Steering Committee
» Investing in Specialist After Care Clinics who are living with the lifelong aftereffects of gynaecological cancers
» Implementing Assisted Human Reproduction Legislation as recommended by the joint committee on Health
Maternity care
Sinn Féin’s priorities:
» Recruit an additional 250 midwives and a further 60 obstetricians and gynaecologists
» Putting the National Maternity Strategy on a statutory footing and implementing it
» Ensuring swift approval, dissemination and implementation of the National Maternity Standards for Safer Better Maternity services
» Ensuring all maternity hospitals have access to foetal anomaly screening, with the requisite staff and equipment
» Expanding new born screening programme to test for a wider range of rare diseases and conditions and introducing legislation to ensure EU standards for new born screening are exceeded
» Introduce mental health assessments as part of a comprehensive maternal health check 6/8 weeks after birth
» Working with nursing and medical unions in the recruitment and retention of medical staff so that all maternity hospitals meet the ‘Birthrate plus’ standard for midwifery staffing, as well as international standards for consultant obstetricians and gynaecologists
Ambulance service
Sinn Féin’s priorities:
» Ensuring the retention of Dublin Fire Brigade’s ambulance service
» Recruiting more advanced paramedics
» Purchasing, equipping and staffing 50 additional new ambulances to be deployed accross HSE regions at a cost of €51.6 million
» Developing a model of efficient, cost-effective patient and inter hospital transfer
» Phasing out the costly reliance on the private sector
» Purchase and staff additional air ambulances
Children’s health
Sinn Féin’s priorities:
» Tackling childhood obesity
» Implementing the National Healthy Childhood Programme
» Legislate for ‘no-fry zones’
» Delivering free dental care for all children and young people under-18
» Increase funding for the Public Dental Service
» Vaccination education awareness campaign
» Increase funding for the National Immunisation Office
» Enhancing end of life and palliative care for children
Rare diseases
Patients should have access to the healthcare and treatment options of their choice and preference, including complementary and alternative therapies and medicines. Unfortunately, in recent years, due to the low level of the HSE budget for new drugs and medicines and the inordinate prices demanded by pharmaceutical companies, patients are missing out on new drugs and medicines
Sinn Féin’s priorities:
» Increasing HSE drugs budget including targeted funding for new medicines
» Expanding new born screening programme to test for a wider range of rare diseases and conditions and introducing legislation to ensure EU standards for new born screening are exceeded
» Implementing the National Rare Disease Plan
» Building sufficient Genetic Services for Ireland
» Introducing a dedicated approval process for drugs for rare diseases in which patients and clinicians have a voice and defined role
» Fast-tracking the establishment of the Working Group to bring forward appropriate decision criteria for the reimbursement of orphan medicines and technologies
» Establishing an all island rare diseases registry
» Ensuring all-Ireland representation on the Rare Diseases Technology Review Group
Healthy Ireland
Sinn Féin’s priorities:
» Increasing funding for Healthy Ireland
» Promoting sport and health-enhancing physical activity
» Legislating to regulate the marketing of junk foods, sugary drinks, intoxicating drinks, and gambling to children
» Ensuring the sugary drinks tax is set at a rate that realises its objective of reducing obesity
» Introducing legislation to regulate the sale of e-cigarettes
» Increasing excise duty on cigarettes and increasing resources to tackle illicit trade and funding to be used for smoking cessation supports
» Increasing supports for problem drinking, problem gambling, and drug use and addiction
» Conduct short review of the gambling sector and introducing regulatory reform of the sector
» Introducing a young men’s health strategy
» Tackling obesity, promoting healthy diets and increasing the consumption of fruit and vegetables
Cardiac Care
Sinn Féin’s priorities:
» Finalise, publish and ensure funding for a new National Stroke Strategy and ensure stroke survivors make the best possible recovery through improved rehabilitation services, including physiotherapy, speech and language, occupational therapy and psychology, that have been proven to reduce overall healthcare costs as well as improving patient outcomes
» Commission a new National Cardiovascular Health Policy to replace the National Cardiovascular Health Policy 2010 – 2019 and to build on the work of the National Review of Specialist Cardiac Services
» Deliver 24/7 Emergency Cardiac Care at University Hospital Waterford to treat patient across the Southeast
» Improve cancer survival rates and increase funding for the National Cancer Strategy
» Implementation of the National Traveller Roma Inclusion Strategy (NTRIS) 2017-2021
» Publication and Implementation of the long delayed National Traveller Health Action Plan
» Effective and compassionate care to those from ethnic and other minority backgrounds cognisant of their differing situations
» Appropriate training for and provision of interpreters
» Providing services in a culturally sensitive manner
» Ensuring proper diversity training for health professionals
» Pass the Sinn Féin Bill to ban so-called “conversion therapy”
» Introducing a HIV action plan and the development of an AIDS memorial on the island
» Provision of a tailored range of health services for those in direct provision based on their health needs
» Investigating use of Sodium Valproate and create dedicated healthcare pathways for those affected
» Implement the Human Tissue Bill and deliver soft opt out organ donation
Implementing Sláintecare
The Sláintecare Report was developed by the Oireachtas Committee on the Future of Healthcare. It was heavily influenced by Sinn Féin. It offers a radical shift in the direction of healthcare from one that has been pushed in the direction of privatisation towards a truly public health service.
There can be no denying that inequality is rife throughout our health system. This inequality manifests itself in some paying more than others for the same care, or families in one part of the country getting access to necessary services denied to those in a different HSE region. Similarly, it manifests in the less well-off dying younger and living less healthy lives, and it manifests itself in those who can afford private health insurance getting to jump the queue – this is not acceptable.
We need to see the full implementation of the Sláintecare report, so we can increase investment in the health system, not simply to provide more resources and capacity but to directly challenge and eliminate these structural inequalities and deliver a truly public health service.
Sinn Féin’s priorities:
» Fully implementing Sláintecare over ten years
» Increasing public investment in healthcare to move from a failing, two-tier health system to universal healthcare
» Introducing a transition fund to cover the costs of moving the heath system to a single tier system
An Irish NHS
In 1989, the then Irish Government signed and ratified the United Nations International Covenant on Economic, Social, and Cultural Rights. Article 12 of that Covenant states that signatories recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
Sinn Féin’s priorities:
» Continued access to citizens in North to the European Health Insurance Scheme
» Widening the individual areas of cooperation between the jurisdictions both in border areas and in areas of specialist medical practice
» Establishment of an Implementation Body in the areas of health promotion and healthcare provision
» Ensuring all-Ireland recognition of health qualifications and standards
» An all-Ireland Integration Committee to make preparations for the establishment of a National Health Service body, subsuming the functions currently carried out by the HSE in the South and the NHS in the North
» An all-Ireland Integration Committee to make preparations for the establishment of an all-Ireland Department of Health under the auspices of an all-Ireland parliament which would have direct responsibility for the delivery of health services through the new NHS body
» Universal provision of healthcare, accessed when needed, free at the point of delivery and funded through general taxation for all citizens across the entire island
Mental Health
A Vision for Change identifies many solutions and key proposals needed to reform our mental health services. It is thirteen years old and remains largely unimplemented. Sinn Féin in Government will not allow this to continue.
Realising the Vision for Change
Sinn Féin’s priorities:
» Publishing an implementation plan to deliver A Vision for Change in full with additional funding of €1.2 billion
» Streamlining recruitment of mental health staff and ensuring decent pay and conditions to retain staff and attract new applicants
» Recruiting a minimum 2000 additional full-time mental health staff
» Increasing child and adolescent mental health teams to 100 and fully staff them
» Increasing community mental health teams to 50 across the state and fully staff them
» Implementing recommendations of the Oireachtas Future of Mental Health Care Committee and Sláintecare
» Empowering an Oireachtas Mental Health Committee to oversee implementation and hold the minister, department and HSE to account
24/7 Care for a 24/7 problem
Sinn Féin’s priorities:
» Delivering 24/7 crisis services within the first term of Government
» Establishing a Crisis House in each HSE catchment area
» Ensuring that every AandE, garda custody suite, and prison has a Mental Health Nurse available on a 24/7 basis
Patient Rights
Sinn Féin’s priorities:
» Legislating for a statutory right to advocacy for all patients
» Increasing funding to advocacy services to meet demand, establishing a dedicated service for children in the services and initiating a campaign to raise awareness of advocacy services
» Legislating for Advanced Care Directives to allow patients to have input into their future care
» Ratifying the Optional Protocol of the UNCRPD
» Fast-tracking a regulatory body for counsellors and therapy services to ensure best practice
Primary Care – accessible care where it’s needed
Sinn Féin’s priorities:
» Investing in Primary Care Mental Health services to ensure access for all to the care and support they need in their community regardless of income
» Ensuring that all primary Care teams include at least one mental health post
» Providing additional resources for primary care teams in areas with higher need or levels of deprivation
» Free universal counselling services with a GP referral at a cost of €25.4 million
» Issuing guidelines to allow longer term (20 sessions rather than the current limit of 8) access to primary care counselling on a case by case basis
» Developing plan to address local suicide epidemics through local taskforces encompassing the Primary Care Team and other relevant community bodies to focus resources
» Implementing recruitment changes recommended by Oireachtas Mental Health Committee to attract new Psychologists for the service
Long term support towards recovery
Sinn Féin’s priorities:
» Providing targeted funding to support tenancies for people with severe and enduring mental health difficulties in order to prevent homelessness
» Greater support for people with mental health difficulties to enter employment and training
Mental health at an early age
Sinn Féin’s priorities:
» Developing curriculum for positive mental health classes at Primary and Second level
» Providing age appropriate suicide prevention training to all second level students through the National Office of Suicide Prevention
» Ensuring full-time guidance counsellor for every secondary school and an additional position for schools over 500 pupils
Suicide Prevention
Sinn Féin’s priorities:
» Building a more fair and equal Ireland
» Delivering 24/7 crisis intervention services including a national 24/7 crisis hotline working with existing services
» Ensure mental health posts covering all AandEs, garda custody suites and prisons and a full complement of Suicide Crisis Intervention Nurses across the state
» Increasing funding for Primary Care counselling to cut waiting times
» Providing suicide prevention training for frontline public sector workers such as Gardai, Nurses, Teachers and those working in public offices
» Providing age appropriate suicide prevention training in schools
» Increasing funding for the National Office of Suicide Prevention by €2.6 million
Drugs and Addiction
Sinn Féin’s priorities:
» Ensure a minister who sits at the cabinet table is given responsibility to tackle this crisis
» Increasing investment in the Drugs Strategy and Drug and Alcohol Task Forces by 12 million and mandating all relevant agencies to fully engage in working together on the delivery of the strategy
» Increase support for services which treat mental health and addiction in conjunction
» Amend existing legislation and publishing guidelines for dealing with Dual Diagnosis of mental health and addiction and establishing a No Wrong Door Policy to ensure that no one goes without treatment because of their addiction
» Increasing the number of medical detoxification and rehabilitation beds by 20
» Ensure a structured outpatient treatment program incorporating an inter- agency partnership approach for everyone released from prison including homeless and mental health services
» Commencing the biggest Garda recruitment drive in the history of the state bringing the service strength to over 16,000 Gardaí, with a focus on community policing
» Recruiting 2000 civilian staff to free up Gardaí from behind desks
» Increasing the number of Gardai and resources in the National Drugs Unit and the establishment of area-based Garda Drugs Units
» Establishing Drug-free zones of radius of 300m of a primary or secondary school with increased penalties for illegal drug-related activities in such Zones
» Establish Prescriptions Drug Monitoring Programme (PDMPs)
