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Sláintecare information ‘severely lacking’, says costs watchdog

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The Government’s spending watchdog has sharply criticised a lack of information about the Sláintecare reforms for the health service.

Basic information is “severely lacking” about Sláintecare despite it requiring substantial and permanent increases in public healthcare spending, according to a report by the Irish Fiscal Advisory Council.

“While the reforms have been under way for almost four years, no budgeting is available beyond one year, no updated costings have been produced since 2017, and little clarity on progress made is publicly available.”

While the reforms were estimated in 2017 to add €2.8 billion a year to public spending on health, pay and other cost pressures “do not appear to have been factored into the original costings”.

This is likely to have driven up the final cost of implementing Sláintecare significantly, say authors Dr Eddie Casey and Killian Carroll. The two economists say factoring in pay and price pressures “should be carried out as a matter of urgency”.

‘Favourable demographics’

Health outcomes have improved in recent decades, with life expectancy now in the top one-quarter of EU countries. At the same time, the rise in Ireland’s public health spending has been dramatic, according to the paper – from 2 per cent in the mid-20th century to 8 per cent before the Covid-19 pandemic.

Ireland is a “high spender” on health internationally – sixth out of 33 OECD countries for government spending on healthcare as a share of national income, the report notes. “This is despite Ireland having had relatively favourable demographics over this time, with an old-age dependency ratio well below the median OECD country.”

Spending on outpatients or daily hospital services is particularly high – with only Finland, Sweden and Japan spending more. And despite a high spend on investment, Ireland ranks about the median on the availability of hospital beds, CT scanners, mammography machines and other key items.

The authors say explaining the reasons for the rise in spending is not easy, though ageing and the general rise in people’s incomes are likely to have played a role.

Ageing and salaries

By 2050, public heath spending could be accounting for 13.2 per cent of national income, the report forecasts. Two-thirds of this increase will be due to ageing and population changes, and one-third to price and wage pressures.

The paper calls for “more realistic” spending forecasts, developed earlier in the budgetary process. Better five-year budgets could be a “game-changer” for managing health spending, it suggests.

They say it is striking that much of the fast increase in health spending in recent years has been unplanned. In the four years running up to the pandemic, health accounted for 56 per cent of total Government spending overruns, even though it only accounts for one-fifth of overall current spending.

Almost 65 per cent of overruns related to pay, with hospital staff budgets running over, often due to unplanned hiring of staff by the end of the year.

The report is critical of “flawed” planning and budgetary management in public health. “The problems in health budgeting are manifold: predictable spending increases are routinely ignored, basic plans are not made in a timely manner, and this contributes to the classic problem of a ‘soft budget constraint’. In other words, the overruns seen in Ireland in recent years appear to be a combination of both poor forecasts and poor controls on spending.”


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Nphet proposes cap on households mixing over Christmas period

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The National Public Health Emergency Team (Nphet) has recommended that no more than four households should mix over the Christmas period.

Nphet met on Thursday to consider advice for the Government on the latest pandemic situation, at a time when Covid-19 case numbers have stabilised at a high level and further information on the Omicron variant is being awaited.

It last night sent a letter to Minister for Health Stephen Donnelly which recommends a maximum of six people at a table in bars and restaurants, the closure of nightclubs and limits on households mixing.

The contents of the letter are expected to be discussed by Ministers and senior officials at a Cabinet sub-committee meeting on Friday.

Minister for Justice Helen McEntee said the Government would move “as quickly as it can” to examine the latest recommendations from Nphet and to decide if further restrictions will be introduced. She said the Cabinet would need to be given time to “look at this advice and take it on board”.

During an interview on RTÉ radio’s Morning Ireland, Ms McEntee said the Government had to ensure it was clear about about what it would do in terms of restrictions and why before anything was announced.

“Of course if there are impacts on businesses at any stage of this…I hope people would agree that we haven’t left people wanting,” she said. “We have always responded where business has needed additional income. Where individuals have lost their jobs. We have always provided that support. This won’t be any different.”

Tests for travellers

Separately, the Government has notified airlines that the introduction of a system of PCR and antigen testing for passengers arriving into Ireland has been delayed by 48 hours.





Confirmed cases in hospital Confirmed cases in ICU


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117

The measure was due to come into force on Friday, but Aer Lingus said airlines had been informed on Thursday night that the regulations would now begin on Sunday. All arrivals into the State – whether vaccinated or not – will need a negative Covid-19 test result from then onwards.

Those travelling with an antigen test result will need to have obtained it within 48 hours of arrival into Ireland, and it will have to be a professionally administered test.

No self-administered tests will be accepted under rules approved by Cabinet. Those with a PCR test result will have a longer pre-travel window of 72 hours before arrival. Persons arriving into the State from overseas who have been vaccinated or recovered from Covid-19 will be required also to have a certified negative test.

Hospitality sector meeting

Meanwhile, Government members are due to meet representatives of the hospitality industry on Friday. Ministers have said there will be supports for the sector if new pandemic measures will impact on their ability to trade.

Ms McEntee said she was particularly conscious that people had been asked to pull back and to reduce their social contacts.

“I am talking to businesses particularly in the hospitality sector and I know the impact that is having on them. This should be their busiest time and it’s not. We are taking this on board. We are going to support all of these businesses as we have always done during the pandemic,” she said.

The Minister dismissed suggestions that the Government was flip flopping or that there was confusion behind the scenes, saying the State is in a “fluid situation” because of the nature of Covid-19.

“What we have seen with the antigen test is that the market has corrected itself. That wasn’t a matter of flip flops or changing. We simply saw the market adjust itself. It is not about Government changing direction. We have to change direction sometimes because of the nature of this pandemic. Everybody is doing their best here,” she said.

‘Random and arbitrary’

Earlier, Maynooth University professor of immunology Paul Moynagh said the latest restrictions reportedly proposed by Nphet could lead to some benefits but seem ed “random and arbitrary”.

He told Newstalk Breakfast that “big mistakes” have been made with regard to messaging to the public.

“Back in September contact tracing was stood down the reason being that children were missing too much school. But we had the option of keeping contact tracing and using antigen testing. And there has been a resistance over the last year from Nphet in terms of using antigen testing,” he said.

“We saw over the last number of days the reluctance of Nphet again to impress advice from experts in the area of ventilation and air filtration. There seems to be this reluctance to accept scientific advice from outside.”

Prof Moynagh said there was a need to look at this reluctance and “learn from our mistakes”.

“Whereas at the moment it seems that mistakes are made and that narrative is defended. And again we end up now with new restrictions that I am not convinced are going to be very impactful,” he said.

“We know they are going to be highly impactful in terms of the sectors for example. I am not convinced by the strategy that is being used at the moment.”


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Senior figures in Washington stand behind Belfast Agreement and protocol, McDonald says

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Senior figures in United States politics have made it clear that the government of Boris Johnson in the UK will face negative consequences internationally if it attempts to rupture or dispense with the Northern Ireland protocol, Sinn Féin leader Mary Lou McDonald has said.

In a presentation at the National Press Club in Washington DC on Thursday she said the protocol was “necessary, operable and going nowhere, despite what Boris Johnson might wish to believe”.

She said she had met with “people of considerable influence” in the US Congress and in the Biden administration on her visit to the US this week and they all stood four square behind the Belfast Agreement and the protocol.

“I heard yesterday on the Hill the clearest possible articulation across the board that any notion of walking away from the protocol would not be acceptable to the United States.”

Asked about a report in the Financial Timed that Washington had delayed lifting tariffs on UK steel and aluminium products amid concerns about threats by the UK to invoke article 16 of the protocol, Ms McDonald said this was a matter for the Biden administration.

However, she said: “There is no doubt where the US stands. If Johnson believes he can walk away from the protocol, he is wrong and there will be consequences for Britain if he chooses that course of action.”

Tariffs

Ulster Unionist Party leader Doug Beattie, who was also in Washington DC on Thursday, said if the lifting of tariffs was being delayed due to concerns about the protocol, he would argue at a meeting with the US state department that it had “got it wrong” in its view on what article 16 was about.

“If people say we have to adhere to the protocol and article 16 is part of the protocol then it becomes a legitimate thing you can use.”

“It is not about whether you should or should not use it. It is about how you should use it.

“You should use it in a narrow sense of a particular issue that is causing economic or societal harm in Northern Ireland, for example, medicines .”

“If the medicine issue has not been fixed and is starting to affect the people of Northern Ireland, it would be right to instigate article 16 to focus minds on that issue.”

Ms McDonald also told the press club event that she expected the United States would “be on the right side” on the controversy over British plans for an amnesty in relation to killings during the Troubles.

She said the British government was going to the ultimate point to keep the truth from the people about its war in Ireland.

She said the Johnson government’s plans would mean “in effect no possibility of criminal action, civil actions or even inquests into killings in the past”.

Ms McDonald also forecast that a point was coming over the coming five or 10 years where referenda would be held on the reunification of Ireland. She urged the Irish government to establish a citizen’s assembly to consider preparation for unity.

She also said “there will be need for international support and international intervention to support Ireland as we move to transition from partition to reunification”.

Separately, asked about a recent Sinn Féin golf fundraising event that was held in New York, Ms McDonald said the money that was raised would be spent on campaigning and lobbying in the US.

She described it as a patriotic expression by people in the US who had a deep interest in Ireland and the peace process.

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Drop in cancer diagnoses as high as 14 per cent during pandemic, early data shows

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The drop in the number of cancers detected during the Covid-19 pandemic could be as high as 14 per cent, preliminary data has suggested.

A report from the National Cancer Registry said it was still too early to provide “definitive answers” on whether pandemic hospital restrictions last year led to a reduction in the number of cancers diagnosed.

The registry’s annual report said an estimated decrease of 14 per cent in detections pointed to the “potential scale” of Covid-19’s impact on other healthcare.

A separate analysis of data on microscopically verified cancers diagnosed last year showed a reduction of between 10 and 13 per cent, the report said.

The drop in confirmed cancer cases, when compared with previous years, could be partly accounted for by “incomplete registration of cases already diagnosed”, it said.

Prof Deirdre Murray, director of the National Cancer Registry, said there were “clear signals that, as expected in Ireland, the number of cancer diagnoses in 2020 will be lower than in previous years”.

‘Very worried’

Averil Power, chief executive of the Irish Cancer Society, said the organisation was “very worried” over the significant drop in cancers diagnosed last year.

The shortfall in cancers being diagnosed would present a “major challenge” in the coming years, with lengthy waiting lists and disruptions to screening services “all too commonplace” already, she said.

Ms Power said it was frightening to think of the people who were living with cancer but did not know it yet. She added that existing cancer patients were “terrified” of having treatments delayed due to the recent rise in Covid-19 cases.

The registry’s report said there were about 44,000 tumours identified each year between 2017 and 2019.

Not counting non-melanoma skin cancer, the most common cancer diagnoses were for breast and prostate cancer, which made up almost a third of invasive cancers found in women and men respectively.

For men this was followed by bowel and lung cancer, and melanoma of the skin. Lung cancer was the second most common cancer for women, followed by colorectal cancer and melanoma of skin.

Nearly a third of deaths in 2018 were attributed to cancer, with lung cancer the leading cause of death from cancer, the report said.

The second, third and fourth most common cancers to die from in men were bowel, prostate and oesophagus cancer. For women breast, bowel and ovarian cancers were the most common fatal cancers.

The report said there were almost 200,000 cancer survivors in Ireland at the end of 2019, with breast cancer patients making up more than a fifth of the total.

Mortality rates

The research found cancer rates among men had dropped between 2010 and 2019, with mortality rates decreasing or remaining the same across nearly every type of cancer. Rates of cancer detected among women had increased between 2008 and 2019, with mortality rates for most cancers decreasing.

The report said the five-year survival rate from cancer had increased to 65 per cent for the period 2014 to 2018, compared with 42 per cent two decades previous.

There had been “major improvement” in survival rates for most major cancers, however, the research noted the chances of survival varied significantly depending on the type of cancer.

Prostate, melanoma of the skin and testis cancer had survival rates of more than 90 per cent, followed closely by breast and thyroid cancer, and Hodgkin lymphoma. Pancreas, liver, oesophagus and lung cancers had much lower five-year survival rates on average, the report said.

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