Universal free GP care, a key element of the Sláintecare plan that proposed a five-year timescale for the health reform strategy, is to be downgraded to a long-term objective, according to Cabinet papers.

The universal programme should be phased in for those on lower incomes first, Minister for Health Simon Harris has proposed.

“The Minister intends to signal support to expand eligibility on a phased basis to move towards universal healthcare in the long-term and agree that income should be the primary basis for phased extension in eligibility,” a Department of Health memo for Cabinet last week stated.

The previous government granted free GP care on age grounds to all children under-six, and the new Cabinet papers would appear to rule out any immediate extension of this programme.

The Cabinet papers, circulated before a discussion on Sláintecare at last week’s meeting in Kerry, also said that the HSE at present is “too big to fail” and “too big to succeed”.

However, new plans drawn up by Mr Harris to reform the HSE have been criticised as insufficient by Minister for Public Expenditure Paschal Donohoe.

Last week’s Cabinet papers show that Mr Harris was broadly supportive of new structures which would see the HSE as a national strategic organisation backed by regional bodies which would deliver care more locally, “subject to the need to minimise disruption to service delivery from such reforms”.

Mr Harris also argued to the Cabinet that a “substantial increase” in the number of civil servants working in the Department of Health – currently running at 453 – was needed, as well as an expansion of office accommodation for the department, given the Government’s plans for health service reform and developments.

Implementation strategy

Mr Harris proposed an implementation strategy for Sláintecare with 104 actions to be taken over three years. However, he told Cabinet that some of the timelines for reforms set out in the all-party Oireachtas committee Sláintecare report last year were “unrealistic”.

He said action and investment under the new implementation strategy would be “frontloaded in those areas that are already under way or can commence immediately”.

Central to Mr Harris’s proposal for new governance reforms of the HSE was the appointment of a new board with a chairman who would work two days per week for a fee of €80,000 per year, while keeping a separate post of chief executive officer. The Minister would also be given powers to give directions to the new HSE board.

However, Mr Donohoe said in his official observations on the reform proposals tabled by Mr Harris that while he supported the moves to establish a new HSE board, “the current draft Bill is not sufficient”.

“A strong independent board for the HSE is an opportunity to reset the relationship between the HSE, the Department [of Health] and the Minister. To achieve this, the proposed structures of a reformed HSE and the associated powers and responsibilities of the board must be clearly articulated in the legislation,”he said.