A PRESCRIPTION FOR CHANGE
3. Local Health and Social Care Services
Fairer, safer and more efficient healthcare
HEALTH PLAN HOMEPAGE
UNIVERSAL HEALTH AND SOCIAL CARE
LOCAL HEALTH AND SOCIAL CARE SERVICES
HOSPITAL REFORM
MENTAL HEALTH
DELIVERING ON RIGHTS FOR DISABLED PEOPLE
STRATEGIC IMPROVEMENT PROGRAMMES
AGING AND OLDER PERSONS CARE
TACKLING ADDICTION, EMPOWERING RECOVERY
SAFE STAFFING FOR SAFER HEALTHCARE
ACCOUNTABILITY AND REFORM
OTHER KEY INFORMATION
Local Health and Social Care Services
Current Expenditure: €852 million
HOME FIRST
Sinn Féin would pursue a ‘home first’ approach to care. We would prioritise the development of home support, intensive home care, and advanced home care services. We would fund an increase of at least 5 million hours and would prioritise funding to expand care in the home over early or inappropriate placement in residential care facilities.
Home care is generally referred to in the context of older people. While older people benefit most from home care, home care is also an important part of supporting disabled people, people recovering from injury or surgery, and more. Home care can range from low-level support to “hospital care at home” virtual wards. It plays an essential role in preventing (re-)admission to hospital, supporting timely discharge from hospital, and ensuring maximum recovery and rehabilitation. We would support the development of advanced home care services using cutting edge technology to prevent, predict, or monitor injuries or conditions.
We would legislate for and fund a modern home care scheme. This would initially include a right to assessment for home care. This would place an obligation on the health service to recognise a person’s home care needs. This would ensure that the health service is incentivised and mandated to first, collect proper data, and then deliver home care where needed at the appropriate level. We would expedite the Health (Amendment) (Licensing of Professional Home Support Providers) Bill and new regulations for providers of home support services in advance. We would develop appropriate career pathways and training opportunities for home and social care workers which recognise and incentivise advanced skills. We would legislate to apply the framework for safe staffing and skills mix across the community and residential care sectors. We would ensure appropriate medical oversight of patients by training more GPs, expanding primary care nursing and therapies, and deploying innovative digital solutions.
Sinn Féin would prioritise the development of public home and residential care services. We would invest in 1,200 community nursing and step-down beds to reverse the trend of privatisation. Only 38% of home support and 16% of nursing home care are delivered directly by the HSE. The vast majority of care is provided by the private sector, with some provided by the community sector. Just 14 large private operators provide 40% of all long-term residential care beds. The payment structure and dominance of a small number of operators have been identified as risks to the efficient and cost-effective provision and distribution of services.
We would ensure continued access to high quality long-term care in a nursing home for those who continue to need it. Supported care homes, sitting between home care and nursing homes, also have an important role. As we expand access to home care, Sinn Féin would repurpose residential care for those with the highest dependency. As a consequence, the type of care delivered in nursing homes will change and the profile of residents will be more complex.
Sinn Féin’s plan would prioritise regular scheduled access to care. As part of this commitment, we would ensure more regular and holistic reviews of the health and care needs of people getting home support and people living in nursing homes. This would ensure that people are in receipt of the type, quality, and intensity of care which they need. We would ensure that supports for housing adaptations, healthy age friendly homes and aging in place are increased to support us to retain our independence as we age, and this is detailed further in our Housing Plan.
Sinn Féin would champion the development of technology-assisted “Hospital Care at Home” and other innovations to improve the quality and extent of care in the home where it is clinically appropriate. Hospital care at home is about delivering better, more appropriate, higher quality care closer to home and ensuring that people are not in hospital when they do not need to be. Hospital care at home has the important added benefit of reducing exposure to hospital-acquired illnesses.
Sinn Féin would task the Commission on Care with reviewing the funding model for residential and home care services. The funding mechanism should ensure balanced regional development, affordable local services, viability, and compliance with employment standards for public services. We would link any additional public funding to the portion of services which are provided on behalf of the State and the promotion of better terms and conditions for workers providing a public service. We would task the Commission on Care to recommend an appropriate industrial relations solution, such as an ERO, for the home and residential care sector. Any solution for the sector should take into account the valuable contribution of family carers, and part-time home care workers and health care assistants. Where nursing homes become unviable for reasons other than a shortfall in public funding, we would ensure that the HSE can step in to acquire that capacity where appropriate.
Sinn Féin Will:
Pursue a ‘home first’ approach to care, develop a modern home care scheme, and prioritise public home care delivery of 5 million additional home support hours
Legislate for a statutory home care scheme which recognises levels of care,
Prioritise the rollout of hospital care at home and the development of advanced, multi-disciplinary home and community-based care
Work with home care workers to improve career development, recruitment, and retention
Deliver 2,000 community beds, including 1,200 short- and long-stay residential nursing beds
Make use of surplus residential care capacity for step-down services where it does not interfere with ordinary access
Enact the Health (Amendment) (Licensing of Professional Home Support Providers) Bill and new regulations for providers of home support
Implement a standardised assessment system for home care needs which ensures a holistic and regularly updated care plan
Mandate the Commission on Care to develop a care strategy and funding model for aging and older people which prioritises independence and care at home
Scale up Healthy Age Friendly Homes
Reform funding of home and residential care to support balanced regional development, affordable local services, viability, and compliance with employment standards for public services
GP Care
Sinn Féin recognises the essential role of the local GP as a gateway to care and a foundational pillar of the health system. The personal relationship between a person and their GP is important and allows the building of trust and familiarity. Sinn Féin would protect that relationship and retain it at the heart of primary care.
Waiting times for access to a GP have increased and there is significant concern at the aging profile of GPs. A recent survey revealed a growing urban-rural divide in access to primary care. It found that just 32% of GP practices in rural areas have capacity for new patients and that while most can offer an appointment within a week, waiting times for non-urgent appointments can be up to 2 weeks in parts of the country. Separately, the Irish College of General Practitioners has claimed that only 1-in-5 GPs are open to taking new public patients and 1-in-4 are open to taking new private patients. Deprived urban areas are also significantly underserved. There are also significant gaps in out-of-hours GP care, and out-of-hours GP services report being under extreme pressure.
Sinn Féin would modernise the provision of general medical services. We would review the existing independent GP contact to ensure it is fit for purpose. We would develop a landmark public-only employment option to cover service gaps in underserved communities where the existing practice model is not viable. This would initially focus on disadvantaged and marginalised areas. This would give young GPs a choice where they do not want to establish their own independent business. It would also support existing practices with dedicated leave cover and enable consistent out-of-hours services. We would initially develop a pilot scheme for emerging blackspots. We would work with GPs to support them to take on young GPs with a view to partnership. We would increase GP training places by 60%, and support access to further training for GPs and practice nurses.
Sinn Féin would prioritise completing the strategic review of general practice and undertake a wider evaluation of the primary care system in keeping with the recommendations of A Future Together: Building a Better GP and Primary Care Service (2001) and Primary Care: A New Direction (2001). This would be anchored by a Working Group on the Future of Primary Care.
Sinn Féin would expand access to chronic disease management programmes with a view to delivering universal access for anyone with a specified condition. CDM in the community has the potential to create significant improvements in quality of life, hospital avoidance, and cost-effectiveness of care. CDM is currently available for type 2 diabetes, asthma, COPD, and cardiovascular disease.
We would establish multi-disciplinary teams and ensure simultaneous expansion across the range of primary care services. In the immediate term, we propose to fund an expansion of primary care staffing, including nursing and management support, through existing partnerships and primary care centres. We propose to establish a Working Group on the development of Primary Care to establish the immediate and ongoing needs of integrated, multi-disciplinary services.
Sinn Féin Will:
Develop a landmark public GP contract and expand multidisciplinary primary care teams
Launch a salaried public GP pilot scheme for out-of-hours and locum support and target 250 public GPs over a 5-year period
Fund an expansion of primary care staffing around GPs, including nursing and administrative support
Expand access to Chronic Disease Management Programmes on a universal basis to those with specified conditions
Increase the use of nursing and advanced practice therapy grades across primary care services, and fund access to training opportunities
Establish a Working Group on the Future of Primary Care with relevant stakeholder professions to guide strategic investment and identify areas for deeper collaboration
Increase the number of GP trainee entrants by 60% (210 places), and support the ICGP to expedite training where appropriate
Establish a multi-disciplinary working group on the development of primary care, complete the strategic review of general practice, and develop a permanent solution for out-of-hours services
Integrate GP as a central pillar of digital transformation
Engage with GPs to ensure sufficient incentives are in place to attract, sustain, and retain rural GPs, and work with GPs to support them to take on young GPs with a view to partnership.
Primary and Community Care
HSE mainstream primary and community care waiting lists have risen by a dramatic 57% under this Government, from 148,000 to 234,000. The vast majority of these people are on waiting lists for physiotherapy, occupational therapy, speech and language therapy. There are acute pressures on ophthalmology, audiology, psychology, and podiatry services as well. Proactive care services such as Public Health Nursing are undervalued. Long wait times impact adults, children, older people, and disabled people. The services needed and accessed by the vast majority of disabled people are provided by mainstream, rather than specialist, community services.
Sinn Féin would double the recruitment target for primary and community care services to tackle waiting lists. We would implement a long-term workforce plan to sustainably reduce waiting lists. We would prioritise reducing community waiting lists equally with hospital waiting lists. Our capital plan would ensure continued delivery of new primary care centres, community radiology services, and clinic space. We would end pay disparities between core service provider Section 39 organisations and the HSE.
In the absence of accessible public services, Sinn Féin propose to fund access to trusted community, voluntary, and private disability and mental health services to ease long waiting times. Funding to private services would be time limited. Private sector outsourcing has never been a sustainable or cost-effective method of reducing wait times and as such building public capacity would be our priority. We recognise the role of the community and voluntary sector in providing dynamic, affordable, and accessible local health services.
Sinn Féin Will:
Implement a long-term primary care workforce plan and recruit at least 10,000 community-based medical, nursing, and health and social care professionals
Emphasise community-oriented training places across medical, nursing, and allied health and social care professions
Establish a Working Group on the Future of Primary Care with relevant stakeholder professions to guide strategic investment and identify areas for deeper collaboration
Develop new primary care centres and community health facilities to expand access to public services and improve the quality of care infrastructure
Temporarily fund access to community and voluntary health services and some private services to assist in tackling waiting lists
End pay disparities between core service provider Section 39 organisations and the HSE
Dental and Oral Health Services
Sinn Féin would invest in public dental teams, including dentists, hygienists, nurses, and technicians, to deliver care to public patients. These teams would bolster public dental services and get the school dental screening programme back on track. Prevention and early intervention are essential in health care, and the opportunity to save your teeth and prevent oral disease is being denied to low-income households by prohibitive costs. This is far more costly to the household and the State in the long run.
Under Fine Gael and Fianna Fáil, nearly half of dentists providing publicly funded care to medical card holders have withdrawn from the Dental Treatment Services Scheme. There are now just 800 dentists on the scheme, down from 1,500 in 2019. According to the Irish Dental Association, 80% of dentists who are still on the public Dental Treatment Service Scheme are not taking new public patients and 93% of dentists do not want to participate in the current medical card scheme. This is hurting low-income households the most, with even basic oral health services being placed beyond their reach by costly out-of-pocket fees.
Similarly, public dental services are regressing. Dental screening in schools and universal oral health services for children have collapsed. Over 100,000 children did not get their school dental screening appointment last year because of a lack of capacity. HSE orthodontic services are also inaccessible, with more than 7,000 of children waiting over a year and more than 2,000 children waiting over 4 years for access to care.
Sinn Féin would develop public dental and oral health services to fulfil the core objectives of the Oral Health Policy Smile agus Sláinte. This would be guided by a working group. We would work with dentists to improve the medical card scheme while expanding public service provision. We would improve access to oral health packages for children through schools and the public health service. This would include general check-ups, screening, self-care skills, and direct access to hygienists. We would engage with dental health care professionals to expand direct access to dental hygienists to improve the availability of preventive care.
Sinn Féin would train, recruit, and retain significantly more health and social care workers to develop public and independent services. We would initially increase dental studies training places by 60 (32%) and implement a multi-annual plan to align training places with service need and future demand for dentists, orthodontists, nurses, hygienists, orthodontic therapists, and technicians.
Both the Dental Council and the Irish Dentists Association have called for legislative reform to improve the powers of the Dental Council to uphold law, regulations, and guidelines. We would progress amendments to the Dental Act 1985 to improve the powers of the Dental Council to investigate and penalise illegal practices.
Sinn Féin Will:
Hire public dentists and dental care teams to target school screening for children and medical card holders
Increase the number of dental studies new entrants by 32% (60) from 185 to 245, and develop a dental workforce training plan
Develop modern general dental services contracts, including a public-only contract, to support the development of public services for public patients
Establish a multi-disciplinary working group on the development of primary care and develop the public model of dental and oral health service provision
Promote prevention of oral diseases through extended school screening and direct access to registered dental hygienists with appropriate scope of practice
Regularly review the scope of dental and oral health services available with public funding to ensure best practice and effective use of preventive and routine care
Reform the Dental Act and empower the Dental Council to:
Take action against unregistered dentists or allied dental healthcare professionals (ADHPs), or registered professionals who are considered a risk to the public due to a serious criminal record or similar
Investigate and penalise dentists, dental professionals, or dental practices, as and where appropriate, which breach the law or professional standards
Recognise and regulate allied dental healthcare professionals (ADHPs) as a professional cohort, including but not limited to hygienists, nurses, technicians, and therapists, and support independent practice of ADHPs
Require appropriate continuous professional development and registration of dentists and allied dental healthcare professionals
Accredit or remove accreditation of relevant training programmes
Specify additional registration criteria as appropriate to support data collection on the number and availability of practicing dentists in the State.
Pharmacy First
Community pharmacy can play a much larger role in the provision of health services. Sinn Féin has long supported a greater role for community pharmacists in common conditions, minor illnesses and ailments, chronic disease management, and medicines management. Community pharmacies can take some pressure off general practice through increased service provision within a pharmacists’ scope of practice and through smarter ways of working. Community pharmacy can also play a role in preventive healthcare such as screening, blood pressure, diabetes, or cholesterol checks, though this must be balanced against appropriate utilisation.
Sinn Féin would implement a common conditions scheme to enable people to attend their local pharmacist for health information, advice, and care. This would operate on the basis of specified assessments, protocols, and treatments for prescribed ailments. A similar scheme to one which Sinn Féin proposed in 2017 has been introduced across Britain and the north called “Pharmacy First” in a bid to reduce pressure on GPs. We are open to a significant review of the scope, funding, and terms and conditions of community pharmacy to achieve an integrated universal healthcare system. This work would be steered by a working group on the development of primary care, which would look at workforce development, administrative burden, ICT systems, remuneration, and legislative changes. We propose to appoint a senior official with responsibility for pharmaceutical policy at the Department of Health to coordinate workforce planning, medicines supply and management, and related matters.
We would empower the pharmacy regulator, the Pharmaceutical Society of Ireland, to conduct more extensive no-notice checks and inspections to ensure public and professional confidence in dispensing protocols and in the new common conditions scheme.
Sinn Féin Will:
Expand the scope of practice and service provision of community pharmacies
Deliver a Pharmacy First model for common conditions and the provision of health information and advice, with an expanded and integrated role for pharmacists in primary care
Develop targeted health screening programmes including blood and cholesterol testing for at-risk cohorts
Regulate for substitution protocols and increase the role of pharmacists in medicines management
Integrate pharmacy into community healthcare networks
Establish a multi-disciplinary working group on primary care and appoint a senior pharmaceutical policy official at the Department of Health
Enact legislation to support pharmacist prescribing and therapeutic substitution,
Implement a long-term workforce plan to increase primary care staffing and address deficits in the pharmacy workforce.
Rural Healthcare
Sinn Féin would establish a Rural Health commission in our first 100 days in Government. This Commission would be mandated to publish a comprehensive 10-year Rural Health strategy in the first year of Government. Our Rural Health Strategy would set the direction for improving the health of rural communities over the next 10 years through health system planning, resourcing, delivery, and workforce development. We would task the Commission to advise on specific measures to support local health services, access to major hospitals, the ambulance service, prevention in rural communities, rural health workers, and better integration between home, community and acute care.
Sinn Féin Will:
Establish a Rural Health Commission within 100 days
Implement a 10-year strategy for rural health services.
Pre-Hospital Care and Ambulance Services
The national ambulance service is not performing at the level communities need it to. Annual performance targets for non-cardiac arrest life-threatening callouts were reduced under this Government to hide the fact that they were dangerously off-target. Too many paramedics are working excessive hours. The Ambulance Service has a workforce plan, but it has not been funded by Government.
Sinn Féin would fund the NAS strategic plan to double the paramedical workforce and the ambulance fleet. This includes operational support. More than 2,000 ambulance staff are needed. That will only be met with a radical increase in the number of paramedics in training, and efforts to increase international recruitment of appropriately qualified paramedics.
The role of the NAS is constantly evolving, and community paramedicine is a developing model of supporting hospital avoidance. Paramedicine and the ambulance service will play a key role in delivering alternative care pathways and urgent care in the community, but the development of these services needs to be supported and resourced. Pathfinder has been an important service development to see and care for more people at home, particularly for avoiding hospitalisation of older people.
Rural communities are being left behind and exposed to significantly higher risk of long-term injury and death because of the underfunding of the ambulance service. As an example, people in Kerry could be reliant on an ambulance coming from Fermoy, more than 100 kilometres away, because of the lack of ambulances in rural Ireland. Recently, services were set to be severely curtailed in Cork and Kerry, where regional ambulance sharing is most pronounced. Funding for 2024 was not sufficient to maintain existing levels of service, and the ambulance service faced roster cuts. Funding had to be found from elsewhere within the health budget to prevent a reduction in services. This is unacceptable. Sinn Féin would ensure that the ambulance service is sufficiently resourced to not only maintain existing services, but expand the workforce and fleet to provide a safer service.
There are outstanding concerns regarding the organisation of ambulance services in Dublin. We recognise the role of the Dublin Fire Brigade in providing ambulance services in Dublin. According to the HSE, there is no formal arrangement for the sharing of services in Dublin. Concerns are repeatedly raised regarding the operation of two control centres for ambulances in the Dublin region which is sub-optimal. The recommendations of the Brady-Flaherty report have not been implemented and we recognise that they are not universally accepted. More recently, a Task and Finish Group was established to break the impasse and recommend a solution to the issues between DFB and the HSE NAS. Sinn Féin would work with NAS and DFB to put in place a permanent, efficient, and above all, the safest possible service which is tailored for the unique needs of the Dublin region.
Sinn Féin Will:
Double road ambulance capacity and conduct a rapid review of air ambulance capacity
Develop advanced and specialist paramedic grades
Expand Pathfinder and community paramedicine care pathways that safely support hospital avoidance
Publish reports on the management and control of ambulance services in the Dublin region and request a set of recommendations from the Joint Oireachtas Committee on Health.
Neurorehabilitation
Community neurorehabilitation teams play a vital role in supporting the recovery of patients with neurological conditions or acquired brain injury. They are essential to maximising rehabilitation for people who have experienced brain injury, such as stroke survivors. They provide a range of clinical services, from physiotherapy to neuropsychology, and include speech and language therapy, occupational therapy, and social work. According to the Neurological Alliance of Ireland, only 15% of neurological patients have access to these teams as only two teams are providing full services. Sinn Féin would fully resource specialist neuro-rehabilitation teams to provide a full service in each Health Region.
The benefits of this programme are clear. It is estimated that up to 42,000 hospital bed days could be saved annually if patients can be discharged to a community neurorehabilitation team. This investment is essential for improving patient outcomes, reducing reliance on hospitals, and meeting the objectives of several strategies such as the Stroke Strategy and the Neurorehabilitation Strategy.
We are conscious that access to a hospital-based neurology services is unequal across the State. Recruitment into several hospitals has been difficult. Sinn Féin would support the development of full and safe neurology services in all of our regional model 3 hospitals, in line with the model of care for neurology services, including sufficient consultant and nursing posts. We would work with clinicians to identify service plans for areas where services have reduced in recent years such as Letterkenny, Wexford, Portlaoise, Mayo, and Bantry.
Sinn Féin Will:
Fund the full delivery of all regional neuro-rehabilitation teams and complementary community sector services, and invest in 50 rehabilitation acute inpatient beds
Develop a service plan for safely staffing all neurology departments and training neurology specialist nurses
Further develop neuro-rehabilitation services such as residential houses, transitional units, community and day services, vocational rehabilitation, and family services.
Transitional and Step-Down Care
There are thousands of delayed discharges from hospital every year due to a failure to plan and align community services with hospital need. This is a significant contributor to the trolley crisis. Along with increasing hospital capacity, we must also ensure optimal use of bed space.
Shifting care out of acute hospitals and towards community-based short-term sub-acute inpatient care facilities is an essential component of Sláintecare reforms. A functioning network of hospitals and community facilities, planned to prioritise care closer to home, will enable higher quality care while also improving the performance of our hospitals. Such facilities would provide rehabilitation and reablement care and time for recovery until a person can be cared for in the home.
Our preference is to build public capacity. While we build public capacity, we propose to resource the HSE to lease appropriate surplus capacity in the private sector, such as in nursing homes. We would reduce funding for outsourcing in this area as public capacity is developed.
Sinn Féin Will:
Deliver 2,000 community beds, including 1,200 short- and long-stay residential nursing beds
Review the scope for model 1 and 2 district, community, and general hospitals to play a greater role in supporting model 3 acute hospitals
Eye Care
It is estimated that 1-in-5 children will have an eye problem. Access to services is highly variable and many children missed the school screening due to COVID. This means that there is a significant cohort of school children whose vision difficulties may be undiagnosed. State support for access to eye care for children aged 8 to 16 is patchy. Some Community Health Organisations have introduced an ‘Over-8’s community ophthalmic scheme.’ This unstandardised approach has resulted in a postcode lottery for services.
Sinn Féin would establish a functional and standardised eye care programme to cover children and to improve the availability of care through optometrists. We would invest in early intervention through primary care optometry for the benefit of children’s lifelong development. We would leverage all ready capacity to reorient care and reduce waiting lists.
The HSE has recognised that a significant amount of eye care which is currently delivered in hospitals could be delivered in the community and in primary care. Sinn Féin would implement a new model of care for ophthalmology and primary care eye services to achieve this. We would invest in our public hospitals to counter the need for people to travel abroad for urgent and much needed eye care.
Sinn Féin Will:
Improve access to eye care for children including a standardised 0-16 eye care scheme
Expand access to community eye care services for qualifying public patients, and support the decanting of services from hospitals into community services
Support the development of specialist Eye and Ear elective capacity to reduce outsourcing
A National Hearing Plan
There are more than 300,000 adults in Ireland with acquired hearing loss. The Irish Longitudinal Study on Ageing (TILDA) has found as few as only one-in-five older people with hearing loss have hearing aids while it has been reported that we prescribe hearing aids at less than half the rate of the UK per head of population. Untreated hearing loss is a contributor to dementia and depression, with as many as 50,000 older people affected by hearing loss-related depression. It can also contribute to physical injury and avoidable ill-health.
The HSE provides approximately 20% of hearing aids to children and adults while 80% is provided through the private sector. Approximately 50% of people avail of the PRSI hearing aid grant while 30% pay the full cost of hearing aids.
We are proposing to develop a national hearing plan to ensure that people receive appropriate hearing supports throughout their lives. This is part of our commitment to taking practical and cost-effective measures which can improve people’s quality of lives and reduce accidents and hospitalisations.
Sinn Féin Will:
Implement a national hearing plan to ensure that people receive appropriate hearing supports throughout their lives, improve access to hearing aids, and reduce audiology waiting lists
Support the development of specialist Eye and Ear elective capacity to reduce outsourcing
A Prescription for Change - Sinn Féin's Healthcare Plan
Sinn Féin has the plan, vision, and determination to deal with the big challenges in healthcare. Our plan sets out in detail how we will deliver better access to healthcare when you need it, improve access to a GP when you need one, and end the crisis in our Emergency Departments.
Our plan will transform your experience of our health service and to deliver fairer, safer and more efficient healthcare.
