Health - review of the year

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.

Election

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?

Strike

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.

Lindsay Tribunal

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.

Organ retention

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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