Elections in June appear to be taking priority over the core principles ofthe Hanly report, writes Arthur Beesley, Political Reporter
It was as if the Hanly review never happened. Micheál Martin was in Ennis on Thursday to declare the town's hospital would, after all, retain its 24-hour A&E unit.
Accompanied by the Fianna Fáil team for the Co Clare local elections, the Minister said the cover would mean "doctors on site" providing 24-hour cover.
Mr Martin and his officials were at pains yesterday to deny there had been any cave-in over the services at Ennis hospital. But with the local and European elections just 10 weeks away, it certainly looks like one.
The Hanly report designates Ennis as one of a cluster of four "local" hospitals in the Mid-Western Health Board region. Such hospitals should function as part of a network with the "major" hospital in the board's bailiwick being the Mid-Western Regional Hospital in Limerick.
The report said many hospitals, including some smaller ones, try to provide a large range of emergency services. "The current situation is not sustainable, either from the viewpoint of patient safety or staffing," it said.
The report added that the full range of A&E services "can only be provided in a fully staffed and equipped major hospital".
Of local hospitals, it said: "Ultimately, there should not be a requirement for on-site medical presence overnight or at weekends."
The report went on to say that the "logistics" of such a development would take some time to implement.
Mr Martin maintains that the recruitment of two on-site doctors for a 24-hour emergency service in Ennis is not at variance with the Hanly policy. It is. Yet this is not the first chink in the policy.
On February 24th, Mr Martin asked the group charged with implementing the report to take account of the public debate on the health reform package, and told it to ensure "that medical cover will continue to be provided overnight in each acute hospital". It is on this basis that the Minster is now denying a Government about-turn.
The Taoiseach, Mr Ahern, endorsed the change in his speech to the Fianna Fáil ardfheis on March 6th when he said all smaller hospitals would continue to have 24-hour medical cover.
All of this takes place against the backdrop of Mr Martin's failure to persuade even some of his Cabinet colleagues of the merits of the policy. In the face of a well-organised campaign against the report, which has seen tens of thousands of protesters take to the streets in the mid-west, a core principle in Hanly has been set aside.
No less than anywhere else, Fianna Fáil is highly sensitive to the electorate in Co Clare where concerns about health reform have added to worries about the future of the range of services at Shannon Airport and the Aer Lingus presence there.
In a county where Fianna Fáil expects to dominate politics, an independent candidate, Mr James Breen, topped the poll in the last general election. The success of Mr Breen, a Fianna Fáil member for 38 years who campaigned on a health ticket, deprived the party of a third seat in the county. The party does not want to repeat that experience.
So even before Hanly makes proposals about services elsewhere in the State, it is hard to see the Government confining 24-hour cover to major hospitals.
The Hanly report said: "A repeated concern expressed to the task force was the influence of politics, whether local or national (political, medical or other), on decision-making in the health services generally, and hospital services in particular."
There is no end in sight to that phenomenon.