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Mary Harney's end-of-year report
[Posted: Wed 21/09/2005 - www.irishhealth.com]
By Niall Hunter-Editor
“He’ll sit there and he’ll say-‘do this, do that’…and nothing will happen.”
US President Harry S Truman predicted this would be the fate of his successor Dwight D Eisenhower, as he handed over power to him back in the early 1950s.
It is not recorded whether the much bruised and battered Micheal Martin gave such a cynical warning to his reform-oriented successor Mary Harney when she took over at Hawkins House a year ago this week.
If the Tanaiste has learned nothing else from her year at the helm it is that it is extremely difficult, and very time consuming to get anything of significance actually done in the health service, no matter how great your reputation as a pragmatic reformer might be.
So, one year later, despite the Tanaiste’s no doubt genuine commitment to seek changes, most things have remained the same.
We still have the ever-present A&E crisis, we still have low income groups without access to medical cards, we still have hospital capacity problems, we still have a very bureaucratised and administrator-heavy health service which has not even begun to grasp the nettle of real reform, we still have an unwieldy and confrontational health industrial relations process that often hinders progress, and we still have major inequalities of access to the system.
Above all, we still also have a health system that tends to move from one crisis to the inevitable other one around the corner.
While Mary Harney's predecessors have had to deal with the blood scandal and the controversy over organ retention, Mary Harney, as soon as she was sitting comfortably in her new office, saw the nursing home charge scandal, although not of her making, fall through the roof.
So it is actually not totally correct to say nothing ever happens in the health system; plenty happens, and most of it is bad news. It’s that old Angola feeling.
Mary Harney to her credit, does appear to have coherent ideas to try to rectify many of the ills of the health service, although to date her plans has tended to be piecemeal, usually concentrating on how private sector enterprise can be harnessed to address specific problems in the public sector.
To date there appears to be no overall plan in place on how to progress the Hanly hospital reform proposals or the need to develop primary care to take pressure off hospitals.
Some would argue that these issues will only be progressed when the 'vested interests' are 'taken on' or brought on board, eg consultants and other hospital staff, GPs, local politicians and pressure groups etc.
To date, any attempt at reform has delivered an ‘us and them’ scenario, with health workers claiming management and the Department just want to provide a deprofessionalised service on the cheap, and the powers that be claiming that reform plans are being held up by special interests who do not want to lose earnings or status within the system, or who simply distrust change of any sort.
All the while, patient groups are in the background chanting that this is all very well but what about the patient on a trolley, or on a waiting list or without a medical card?
It is indeed a long way from the health service 'partnership' model much-talked about not too many years ago. There is little sense of partnership in the health service today, just a lot of hard-pressed workers blaming the Government, and sometimes, other workers, for flaws in the system, and the Government playing the vested interest tune when the going gets tough.
Mary Harney's message has been she agrees with the need for more resources, but this comes at a price of having more transparency and accountability and changing how things are done.
The interest groups' reply that this is a red herring and an excuse for not increasing health spending to adequate levels.
There surely is a better way and a middle ground, and the Tanaiste has no doubt been frustrated at the polarisation and bureaucratisation within the system.
Her 'better way' appears to be to harness the private health sector to ease the pressures on the beleaguered public system.
In spite of a relative lack of success over the past year, the Tanaiste has been helped by a largely sympathetic media, save the odd commentator still obsessively concerned with 'Thatcherism'. One gets the feeling that if Michael Martin had still failed to reduce trolley A&E figures a year after an action plan had been announced, he would not get as sanguine a response from the fourth estate, which appears to be prepared to give Mary Harney more time to solve the unsolvable problems of the health service.
There appears to be an inherent sympathy in media and commentary circles to Mary Harney'’s obviously genuine desire to get things done, to and to what some would see as an eccentric ambition to stay in Hawkins House indefinitely.
The general public too, appears to be relatively sympathetic to her quest, although patient support groups have been highly critical that promises on A&E have not as yet been delivered upon.
An irishhealth.com readers' poll in April showed that more than 50% of viewers gave her 'fair to very good' rating.
A review of how the Tanaiste has performed over the past year would probably lead to an assessment of ‘promising, but could do much better’. By her own high standards, Mary Harney will be frustrated by how little has actually been achieved over the past 12 months.
Looking back at the past year, on moving into Hawkins House, the Tanaiste was immediately tasked with dealing with the nursing home charges crisis.
The Minister, some months later, in the wake of the Travers report, said the whole issue was a major financial, legal and administrative problem that was entirely avoidable.
The issue had been made even more problematic by the Government's cack-handed introduction of an Orwellian-type legislative measure, subsequently deemed unconstitutional, that implied the illegal charges had all been a bad dream and had been legal all along, apparently.
Former Department Secretary General Michael Kelly later told irishhealth.com that he was angered by the Tanaiste’s rather barbed comments about his role in the nursing home charges affair.
Some felt the Travers report came down too heavily on the role of health administration in the nursing home affair, and let the politicians off the hook too easily. Mary Harney however, would probably not agree with that analysis.
At the end of 2004, amidst all the bad news about the nursing home issue, we could pause to rejoice. Waiting lists had been abolished, apparently. The National Treatment Purchase Fund, a PD invention which to its credit has achieved some success in reducing lists, said it was not able to verify the number of patients on waiting lists and would instead be setting up a patient treatment register.
This register, introduced in July, is certainly a more sensible system for calculating lists and trying to give people access to treatment where possible, but the waiting lists are still very much there, although the numbers appear to have been reduced in Dublin. Figures for hospitals outside Dublin have yet to be published.
Also at the end of last year, patients on trolleys and waiting lists breathed a sigh of relief as administrative workers in the health service were all assured that their jobs and pensions would be safe when the new HSE was introduced on January 1.
Many were puzzled by this, as there had never been any overt indication that the administrative reforms would threaten jobs. There had not even been much talk of voluntary redundancy packages.
While obviously the unions had to look after the interests of their members, the agreement with administrative staff seemed a little unreal in view of the wider problems in the health service.
One job loss which Mary Harney did have to deal with at the end of last year however, was that of Aidan Halligan, who turned down the post of CEO of the new HSE. Eventually, after a will-he-won’t-he saga, Prof Brendan Drumm took up the post in August. He seems to share the same reforming zeal of the Minister and one hopes that he will not become too disillusioned too quickly.
Mary Harney's big plan during the past year has been her 10 point programme to improve accident and emergency services, and it is on this that the Tanaiste has receive perhaps the most criticism, as while some limited progress has been made, the plan has not come anywhere near resolving the A&E crisis.
Despite the Tanaiste's somewhat unwise assurances last year that there would be quick improvements in A&E, there has been a slow realisation that it is not a crisis that has an instant solution, and that you have to solve the bed capacity crisis before you solve the A&E problem.
Brendan Drumm has made a realistic assessment of this and has said that improvements in A&E could take two years or more.
Looking through the 10 points in the Tanaiste's plan, while there has been some progress on providing more step down facilities and home care packages, and, after much public concern, some limited progress on hospital hygiene, little has been heard about minor injury units, or the promised better access for GPs and their patients to hospital tests.
There are reported funding delays holding back the opening of new acute medical units and the provision of additional GP out-of-hours services has been slow and has met with the opposition of doctors opposed to these services being privatised.
Everyone appears to agree that the A&E crisis will not be dealt with properly until the hospital capacity issue is addressed. During the summer, the Tanaiste came up with an innovative plan to build new private hospitals on the campuses of public hospitals in order to free up 1,000 more beds for public patients in the main hospitals.
Her argument is that this will be a cheaper and quicker alternative to waiting for 1,000 new beds to come on stream in the public system, and it will provide for a clearer division between public and private care which will ultimately benefit equity of access to care.
While concern has been expressed about some commentators about harnessing the 'for profit' private health sector to bale out the public system, many would argue that patients will not care who is or is not making a profit as long as they have fair and quick access to treatment.
In addition, Mary Harney's message appears to be that the public system needs all the private sector help it can get.
While much of the opposition to Mary Harney's private bed plan to date has been on ideological grounds, there are also practical concerns that even taking this plan into account, the Government’s target for 3,000 additional beds in the system will not be met by 2011.
Also, it is not clear what the Tanaiste's plans are to provide a comprehensive system of continuing care facilities which would take pressure off acute beds. This issue is particularly urgent in view of our ageing population.
An added difficulty is that the private bed plan will be linked to much-needed talks on more flexible contracts for consultants, which could prove to be a long and difficult process.
The announcement of the doctor visit card last November was welcomed by many, including (tentatively) by the IMO, which subsequently refused to operate the scheme following an industrial relations row. Both the IMO and management blamed each other for the row over the card, indicating yet again the poor state of industrial relations in the health service.
Nearly a year later, 200,000 people on low incomes, who do not have a regular medical card, still have no means of accessing free GP care, although there is now hope that agreement can finally be reached on the introduction of the card in the near future.
The IMO and other bodies had been calling for some time for the 200,000 excluded patients to be given full medical cards, but the Tanaiste rejected this as too costly, particularly in terms of the knock-on drug costs involved.
Mary Harney has pledged to take action to control spiralling State drug costs, and faces tough negotiations with the pharmaceutical industry on this later this year.
The Tanaiste, in her time in office so far, has tried to spread an upbeat message that things can be done to improve our beleaguered health system and has adopted some innovative approaches to resolving problems which have been the bugbears of the system for years. However, patients looking for improvements in the system will want to see some results fairly quickly.
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Peadar(KAS11042) Posted:
21/09/2005 15:16 |
| One year on and the Minister still has not ensured that the new Treatment Room in Monaghan is opened; she has still not sanctioned the CT scanner, which is urgently needed; she is still not utilising the state of the art Theatre, three consultant surgeons, theatre staff, nursing staff and BEDS in Monaghan to relieve pressure on other hospitals. Instead she is asking the taxpayer to pay the high price of having those on waiting lists treated in private facilities or abroad. She is making us believe that Private For-profit health services will solve our problems, even though that has not happened in other countries where it was introduced. She is not listening to those who can advise her on more appropriate, more economic, more efficient and good quality methods of solving the hospital problems. Instead she listens to those who might gain financially from the plans. |
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John(johnwilliams) Posted:
23/09/2005 08:25 |
| I think Nial Hunter gave a very good resume of Mary Harney's first year in office. One statement of his with which I disagree is 'opposition to Mary Harney's private bed plan to date, has been on ideological grounds'. It is Mary Harney who is the ideologue. She has Thatcher-like tunnel vision - private good, public bad. The overwhelming evidence from health systems around the world is that for profit health services while good at making money for the companies behind them are a disaster for the general good. If Mary Harney remains in health much longer the changes (not reforms) will become embedded and be impossible to reverse. |
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Peadar(KAS11042) Posted:
23/09/2005 14:16 |
| Well said Johnwilliams. Not only will they be irreversible but the cost in monetary terms will be astronomical and we will be unable to estimate the damge caused to peoples health. Equality of access and equality of care will be non-existent and it will be most vulnerable in our society who will suffer most. |
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