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by Fergal Bowers
editor of irishhealth.com
Health can be very bad for your political health - ask Micheal Martin who as Minister experienced a particularly difficult year. Having previously held the education brief, he learned that there are some hard lessons in the health service too.
The omens were bad from early on in the year after, his colleague in Finance, Charlie McCreevy warned that if health spending kept rising at its current rate, it could jeopardise Ireland's economic prosperity.
Health was one of the dominant issues in the General Election campaign. But Micheal Martin was left wondering what he had done so wrong to encourage the Taoiseach to put him back into the health portfolio, after the General Election - especially now that money in the kitty was running out.
Martin - a year to forget.
During the election campaign, when asked if Micheal would be going back into health should Fianna Fail be returned, Bertie Ahern said he would 'love to give him another five years'. It sounded more like a prison term.
There was a lot of harsh medicine to deliver after the election: higher charges for drugs, for health insurance, for A&E treatment, and even job cuts in the Western Health board. Micheal blamed his own officials for issuing a letter, apparently without his knowledge, cutting grants to carers of mentally handicapped children, and the measure was reversed.
The promise to give medical cards to 200,000 people on low wages from next year was put on ice. Health by a thousand cuts cried the opposition. Some cynics suggested that the National Health Strategy be entered for the Booker Prize for Fiction. The Irish Medical Organisation called the Strategy a 'dead duck'. What hope for the 'world class health service' promised in the election campaign?
Micheal also had to deal with the first strike by junior doctors in 15 years over attempts to cut their working hours and pay, without agreement - an issue which will spill into 2003. The dreaded 'abortion' issue also resurfaced earlier in the year and there was a double whammy for Martin when as campaign leader, the referendum was lost nationally, and also defeated in Micheal's own constituency.
McCreevy - battle with Micheal Martin over poor performance of health service.
While Micheal insisted that he had a good working relationship with his 'friend' the Finance Minister, the body-language and particularly the correspondence between the two spoke otherwise. Highly controversial letters were secured under the Freedom of Information Act. These were no love letters. The Finance Minister wrote of his 'dismay' and 'considerable' alarm at the failure of extra funding to deliver a better service, despite getting well over 8 billion euro a year. When the Finance Minister took back millions of euro that could not be spent on the Waiting List Treatment Fund scheme, people knew who was boss.
Indeed, if there was one big theme during the year is was the need to overhaul the health board administrative system. And yet, Micheal seemed to defend the existence of 11 health boards in the face of deep dissatisfaction with the administrative bureaucracy. A major independent review of the health service structure, promised by the Govt, is due to report in January and should make interesting New Year reading.
It was the year when the Medical Council found social-campaigner Dr Moira Woods, guilty of professional misconduct after a long inquiry into claims that she had erred in diagnosing child sexual abuse among children from a number of families. The Report also criticised management at the Sexual Assault Treatment Unit at the Rotunda Hospital and warned about the potential for future such mistakes.
2002 was the also year when the Lindsay Tribunal report was published, and was greeted by haemophiliacs infected with HIV and Hepatitis c with deep disappointment. Its apparent failure to deliver strong findings and recommendations was compared to the powerful language of the Flood Report. Micheal Martin welcomed the Lindsay report and seemed out of step with the mood of the people to it. His commitment to another probe into the role of US drug firms in the infection controversy was also challenged when his colleague at Justice, Micheal McDowell said pursuing this area could be a monumental waste of resources.
Health service reform - top agenda item for 2003.
Widely regarded as hard working and dedicated, sometimes Micheal seemed in too much of a rush and there were red faces when the Minister's car was caught speeding at over 80 miles an hour. Perhaps he was in a hurry to launch another one of his dreaded task forces or review groups.
The Department of Health was famously described by former incumbent, Brian Cowen as Angola, full of unexploded mines. If that is true then, under fire from many quarters, by year end, Micheal Martin was definitely in the bunker. Parents for Justice pulled out of the Organ Retention Inquiry after a bitter row with the Minister over the need to give the inquiry real powers; a third blood tribunal seemed inevitable after more revelations in the Blood Bank, which also suspended its Chief Executive and then reached an out of court settlement with him to depart.
And, at year end, the Monaghan Hospital controversy brought home in a tragic way how the health system, despite significant investment, needs major reform. Blaming Micheal personally for the Monaghan tragedy was not fair - even he was taken aback at the gulf between the Independent Review report and the report of the North Eastern Health Board.
The year ahead
Micheal Martin looks ahead to 2003 with serious problems ahead: big job cuts in health to be negotiated; funding for health boards next year below the level needed to maintain existing services; more inquiries and tribunals; a strike by public health doctors and hospital waiting lists heading in the wrong direction.
And, the Health Strategy remains in doubt. Sorry, did I mention the health strategy again. New Year resolution - do not mention the health strategy.
So, the prescription for health in 2003, even more harsh medicine ahead.
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Last Reviewed: 1st January 2003
|kevin(kkelleher) Posted: 03/01/2003 11:30|
|Why is 11 health Boards inefficient but 30 local authorities not? maybe we actually need more health boards who are closer to the people?|
|Anonymous Posted: 03/01/2003 12:59|
|We need health services which are run by people who know what real health is about,at the moment the health service is run by civil servants who have no experience of heatlh care of any kind,e.g many of the civil servants who worked on the recent health strategy came from the dept of agriculture to the dept of health and children!!!!!!!!!!!In local authorities you are very much in touch with the public,what member of the public ever gets near a hospital or community care General Manager-they are strongly defended by at least one robust secretary!And as for "the boys at the top" how can a member of the public ever access them ,by a letter which in many cases never gets acknowledged.We need much greater transparency and decision making powers near to the centre of the action,ie at the interface between client/patient and the treating clinician whoever that may be.|
|Anonymous Posted: 03/01/2003 14:32|
|2003 doesn't bode well for those who prefer prevarication. Somebody will have to decide whether to spend money on 11 people in 11 healthboards doing the same job, or on a dialysis machine. The waste of internal resources in each and between healthboards, through lack of communication and political in-fighting is a disgrace. Imagine the savings possible through a centralised purchasing system for stationery items alone. The only proviso should be proof from the Department of Health that savings from manpower cuts have been allocated to improved GP and hospital services for patients. And, if we need to send people abroad for operations to cut waiting lists, how can the UK send people here to reduce theirs?|
|maria(riaria) Posted: 03/01/2003 18:45|
|The increase in administrative staff in health boards is truly astonishing.These health boards then show a truely amazing ability to not do an effective job. how many of you know that the health boards and dept have spent millions of euro setting up databases to identify people with disabilities and yet people with autism have been excluded!After all the money that has been dished out by the govt to families of people with autism because of the govt failure to provide a minimal service, when they do develop a database they exclude autism. i do believe nobody really gives a damn if my little girl ends up in a psychiatric hospital for the rest of her life. we call ourselves civilised but we treat our fellow country men like dirt every day of the week. stop winging about the government and take responsibility|
|Anonymous Posted: 03/01/2003 23:02|
|Minister Martin is not immune from blame for the Monaghan Hospital tragedy, as you suggest. The potential for such tragedies, was flagged to Minister Martin well in advance by the Monaghan Hospital Action TD Paudge Connolly, and prior to Deputy Connolly's election, by the Hospital Retention Committee since 1982. Instead of taking the necessary steps to retain Monaghan General Hospital, Minister Martin and his predecessors presided over the steady removal of the Hospital's constituent Departments by the North Eastern Health Board. Then the College of Anaesthetists and the Royal College of Surgeons both announce that a sufficiently wide case-mix doesn't exist (How could it ??) at Monaghan to enable these professional bodies to permit their NCHD's (or trainees) to train at Monaghan General. And this is the reason cynically advanced by the NEHB Executive for their decision to further deplete this fine Hospital. Then the NEHB try to justify their Pontius Pilate - style attitude to the baby Brónagh Livingstone tragedy, by diametrically opposing the Independent Review Report. The NEHB Executive already have lives on their hands, both of which were denied a fighting chance by the Executive's intransigence. They make me sick, and their resignation is long overdue. Incidentally, when the Hospital was known as Monaghan COUNTY Hospital (and run by the County Council) none of these problems existed, and the Hospital was renowned for the quality of Healthcare it provided, with a full range of Departments, and a dedicated staff.|
|Anonymous Posted: 06/01/2003 10:21|
|Health Boards should be abolished. And Hospital (mis)MANAGERS should be slimmed down and made ACCOUNTABLE. Health boards and hospitals are so top heavy with so called managers that no one needs to or does take responsibility or accountability for any thing. Every thing is some one elses responsibility. IT.S LIKE PASS THE PARCEL. Regarding the sad case of the baby dying,and the mother being put into an ambulance unaccom panied by nursing or medical staff THE HOSPITAL AND HEALTH BOARD IS RESPONSIBLE. Is a health minister to stand in every hospital,health centre.health board 24 hours a day 365 days a year to ensure the correct decisions are made. People in management need to manage and make decisions and stand over these decisions. What is needed is promotion on merit and ability. A slim management who are competent effective, efficient, and who are accountable and held responsible. But will that happen? The present Promotion/appointment/selection system is a joke. But until this is sorted out no more money should be put into the health service. Things willjust get worse. It,s throwiug good money after bad. Happy 2003. Mairead.|
|Anonymous Posted: 09/01/2003 09:38|
|Prevention is better than cure.... if the money goes into health promotion and sickness prevention now - increased health services will not be needed in the futute. So lets take the long term view.... health promotion departments are the key to the future(eg GP referral schemes)and 100% government backing....|
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