A pre-election survey by the charity Alone has found “poor health” is the primary worry of older people. Respondents were specifically concerned about the “ability of the healthcare system to support them when they need it”.

This is a shrewd question that all of us, no matter our demographic, should consider before casting our vote on Friday. Much like death and taxes, it’s difficult to avoid the need for healthcare at some point. And with confidence in the public system comprehensively dented in recent years, its ability to meet our needs is a good yardstick by which to measure politicians’ promises for the service.

With total spend on health recovering to €13.2 billion annually, representing more than 10 per cent of our national income, we are now above the OECD average level. So money is no longer the real issue – it’s how and where we spend it.

The Irish health system is overly hospital-centric. Despite all the rhetoric, it was ever thus. Even with recent reversals of spending cuts, it is hospitals that have attracted the bulk of the returning funds. The Government policy of extending free GP care to the under-12s and the over-70s, while popular, is being carried out with no additional investment in general practice. The primary care sector has never been properly developed in the Republic; under-pressure GPs are referring greater numbers of children under six to emergency departments as a tsunami of increased attendances follows universal free entitlement for this group.

Without a proper primary care infrastructure in place, increasing the number of people entitled to free care will simply collapse an already creaking service.

Several of the main parties are proposing to extend free GP care in the lifetime of the next government. Labour is promising that no one will have to pay to see their GP by 2021, while Fine Gael say all children will have free GP care. Renua has derided “freebie” GP care, promising to “prioritise” the sickest in society but without offering specifics.

Value for money

Fianna Fáil’s manifesto aims to “rebalance the health budget towards primary care” and “support general practice”. While a step in the right direction, the party’s proposal to recruit an additional 250 GPs by 2021 will barely cover retirements and emigration, let alone numbers to allow more care in the community.

Of course while steering the health system monolith towards greater balance, the current risks in the system must be managed. How do politicians propose to reduce hospital waiting lists and bring down the numbers on trolleys? Fine Gael proposes a dedicated fund of €50 million a year to reduce waiting lists, while “measuring and improving patient experience times in emergency departments”, is a somewhat tired indication that the present Minister for Health has thrown everything he has got at the problem.

The acute services section of the Social Democrats’ policy is labelled “Build an Irish NHS” and encompasses trolley numbers and waiting times for surgery. Fianna Fáil’s policy is hospital-focused but in a vague way. Labour’s is “hospital-lite” with its emphasis on a new community health service, while Renua’s proposals for acute hospitals include establishing hospital trusts with competition between them as well as the concept of “deep specialisation” for elective work.

A number of commentators have called for the depoliticisation of health and this is echoed by the Social Democrats and Renua. The former say they will urge all political parties to sign up to 10 principles on framing a new national health service.

Such cross-party support allowed Aneurin Bevan to introduce Britain’s NHS after the second World War and this would be an excellent model for taking party politics out of health in Ireland, according to the Social Democrats. Renua is proposing a national health forum to develop a 24-year plan for healthcare.

Lack of vision

While voters may be attracted to specific pledges such as an extension of free GP care to specific groups, it would be a mistake to avoid taking a longer view when answering the question: “Will the health service be able to support me when I need it to?” For someone in middle age, decisions taken now will decide the quality of the health service they will experience in 10 and 20 years’ time.

Regrettably, there is little in any manifesto that addresses the elephant in the room. There are no specific plans to abolish the monolith that is the HSE or even to change its culture by insisting on proper accountability by health service managers. Without this, there will be more Portlaoise babies and Susie Longs to lament in the years ahead. Dr Muiris Houston is the health analyst at The Irish Times