Healthcare is a Right - Mini manifesto

May 11, 2007

Sinn Féin believes that healthcare is a fundamental human right. We now have the resources in this State to realise this right for everyone: not only to ensure that all people have equal access to world class health services, but also to effectively tackle the factors leading to poor health for many - social and economic inequality.

While health spending has increased under the current Government, they have stubbornly maintained the unequal two-tier public-private system, thus wasting public money in a system that is not only inequitable but inefficient. The symptoms of consequent crisis in our health services are well known - manifested in the scandalous situation in A&E units, long waiting lists and the shortage of beds and staff.

In an era of unprecedented wealth and spending on healthcare the continued inequalities in health and in access to health services are inexcusable. They are an indictment of successive Governments run by all the establishment parties.

Many parties now make claims about opposing the two-tier health system. But only Sinn Féin has a credible plan to establish healthcare on the basis of full equality.

The Sinn Féin Healthcare Reform Package

Sinn Féin proposes a new universal public health system for Ireland that provides care to all free at the point of delivery, on the basis of need alone, and funded from general fair and progressive taxation.

We are also proposing fundamental re-orientation of the health system to adopt a central focus on prevention, health promotion and primary care (including mental healthcare and full spectrum addiction treatment services), and on ultimately eliminating the underlying social and structural causes of ill-health and premature death, such as poverty and inequality.

We plan to restructure the health service to reconfigure delivery on an all-Ireland basis to make it more efficient and locally accessible, by introducing a single All-Ireland Strategic Health Executive to oversee all services. And we plan to make delivery more responsive to the communities served by establishing locally accountable Community Health Partnerships bringing together public representatives, service users, advocates, health professionals and systems experts to collectively manage delivery of all local health services on the basis of need.

We plan to enshrine the right to healthcare in the 1937 Constitution, in a future All-Ireland Charter of Rights and in legislation, making this a fully enforceable right in Irish courts. We also plan to establish a Health Ombudsman to provide an administrative remedy short of the courts, in the interests of speedier and less expensive resolution of disputes and redress regarding violations of the right to healthcare.

Furthermore, we will introduce equality-proofing and human rights-proofing to all health policy, law and practice, and public health-proofing of other areas of law and policy. Of course, pursuing the other aspects of our economic and social programme will increase social and economic equality and therefore have a positive impact on health outcomes for all our people.

The Sinn Féin Record in Leinster House:

• Our Dáil Team stood firm in support of the public system and public patients and led the fight against privatisation, including the allocation of land at public hospital sites to developers of private hospitals - a scheme that has no mandate and is being fast-tracked in the run-up to the general election.
• We fully supported people campaigning across the State for services to be retained in their local hospitals
• We initiated a Dáil debate on the failures of the current healthcare system and used the opportunity to set out our positive proposals for a universal health system based on equal access for all.
• With our party, we launched a campaign for Healthcare as a Right, meeting healthcare workers, local groups and the general public throughout Ireland.

Sinn Féin Priorities in Government:

A Phased Introduction of Universal Healthcare as a Right

• Begin to reverse privatisation of healthcare by immediately ending tax breaks for private hospitals and the land gift scheme and investing all health funding in the public system.
• Provide full medical cards for all under the poverty line and all under-18s (as a transitional measure towards a fully universal public access service) in the first Sinn Féin Budget.
• Make all new hospital consultant posts public-only.
• Ensure working conditions, promotion prospects and remuneration sufficient to maintain trained staff in the public service, halting the exodus from the public system and from the country.
• Immediately establish a Healthcare Funding Commission to report within a reasonable time-frame on the projected costs of the transition to an all-Ireland system of universal healthcare provision (taking into account all spending on health services under the current systems, including state funding and spending on private insurance), and to make recommendations on how the State can best harness our resources in the interests of more equitable and efficient delivery.
• Hold a referendum to amend the current 1937 Irish Constitution to include the right to healthcare.

A New Emphasis on Primary Care and Prevention

• Develop a network of modern and accessible Primary Care Treatment Centres run by properly-resourced multi-disciplinary and multi-agency Primary Care Teams. Start this process by completing the rollout of the Primary Care Centres promised throughout the State on an accelerated timetable.
• Appoint salaried GPs to work in the Primary Care Teams and negotiate to phase in salaried contracts for all other GPs.
• Make advanced screening services (ie national breast and cervical cancer screening) available locally, promptly and widely - based on risk criteria rather than age alone - to ensure early detection of cancers and other illnesses.

Equality in Hospital Care

• Introduce a timetabled and fully resourced strategy to deliver into the public hospital system the additional 3,000 hospital beds required.
• Plan for enhanced provision of essential public nursing home beds, community care facilities and home care, to take pressure off A&Es and ensure care delivery in the most appropriate setting.
• Halt the over-centralisation of hospital facilities, reverse cutbacks in services at local hospitals, and institute a national plan for the provision and resourcing of hospital care, including clear access targets within an equality framework.
• Configure all hospitals to ensure that emergency services are available as locally as possible. For the vast majority of the population, these services should be located less than 45 minutes travel time away. No one should be more than one hour's travel time from an A&E unit when the three critical access factors are taken into account: hospital location, road conditions and ambulance provision.
• Invest significantly in the ambulance service, including upgrading of the existing fleet, and introduce an air ambulance fleet.

A New Emphasis on Mental Healthcare

• Fully implement the Mental Health Act 2001 and the recommendations of the Government's Mental Health Expert Group as set out in their report A Vision for Change (2006).
• Introduce a spending programme to counteract decades of underfunding, followed by ring-fencing at least 12% of the health budget for mental health services, as recommended by the UN World Health Organisation.
• Reconfigure primary, secondary and children's/adolescent mental healthcare services to manage a shift away from secondary services over the next 5-10 years, so that the vast majority of mental healthcare is provided by Primary Mental Healthcare Teams (providing a 24 hour service).
• Establish a network of step-down services and other comprehensive community supports for transition out of secondary care facilities.
• Establish an All-Ireland Mental Health Commission to promote and implement the best standards of care within the mental health services and to fund research on an all-Ireland basis.

Suicide Prevention

• Invest in further clinical and community-based research on suicide prevention and produce a fully resourced, comprehensive All-Ireland Suicide Prevention Strategy.

Full-Spectrum Drug and Alcohol Treatment Services

• Expand the spectrum of drug and alcohol treatment services available and dedicate adequate funding to eliminate treatment waiting lists.

Rights-Based Hospice and Palliative Care

• Establish a timetable for implementation of the 2001 Report of the National Advisory Committee on Palliative Care.
• Ensure regional equity in the delivery of hospice and other palliative services.
• Introduce a state-funded scheme for Compassionate Care Leave.
• Provide funding for the development of paediatric palliative care.

Justice for Victims of Healthcare-Related Scandals

• Establish a statutory inquiry into the scandal of organ retention in the Irish health system.
• Carry out an investigation into the barbaric practice of symphisiotomy.

New National Children's Hospital

• Proceed with the new National Children's Hospital at the Mater Hospital site as a centre for provision of tertiary paediatric services. This new hospital should provide services on an all-Ireland basis and should include services that are not currently provided on the island of Ireland and for which children have to travel abroad.
• Retain the maximum possible number of paediatric services and in-patient beds at Tallaght Hospital. Prevent the closure of the current Children's Hospital there.
• Retain Crumlin Children's Hospital as a child-focussed healthcare facility, including primary, secondary and tertiary care for children.
• Increase the overall hospital bed capacity for children.
• Put in place a coherent structure to co-ordinate acute hospital services in the Dublin region, maximising the resources in all the hospitals in the capital to ensure their most effective use.
• Provide appropriate paediatric hospital services in the regions.