Despite all the promises, a world-class health service is a long way off Theresa Judgeexamines the state of our health service, and looks at what the Government promised and what it actually delivered
"The development of a world-class public health service is a core objective for us."
This was the first line of the health section of the Programme for Government drawn up by the Fianna Fáil and the Progressive Democrats in 2002. Numerous pledges followed, only some of which set out measurable, time-specific targets.
However, key measures of the health service - waiting times for treatment, A&E queues, medical card provision, MRSA levels and cancer services - indicate that we are still a very long way from "world-class", and dissatisfaction over these shortcomings is one of the main problems for the Government in seeking re-election.
The nurses' dispute, the breakdown in talks on consultants' contracts and public dissatisfaction with the management record of the HSE all contribute to a sense of a service riddled with problems.
A spokesman for Minister for Health Mary Harney says there has been "significant and sustained improvement in our health services over the last five to 10 years". He says that while the objective of a world-class service has not yet been achieved, "the thrust of the health reform process has been to that end and it is a work in progress that is achievable".
In the programme, the Government also said it would "encourage the end of the two-tier health system by ensuring public patients will have access to timely and quality services".
According to Harney's spokesman, this has been advanced in a number of ways, the first being the planned redesignation of 1,000 private beds in public hospitals for public patients through the building of co-located private hospitals on the grounds of public hospitals.
Therefore, while all Opposition political parties say the planned co-located hospitals are consolidating the two-tier system, Harney is saying it is her main strategy for ending it.
The latest deadline for the signing of legally binding agreements for the building of these eight hospitals is the end of May. If it slips any further, the whole plan will be scraped if there is a change of government.
Harney's spokesman says progress to end the two-tier system has also been made through the National Treatment Purchase Fund (NTPF) as it is giving public patients access to private hospitals. Finally, he says, "one particular feature of the new consultants' contract that is not in dispute, is that there will be greater equity for public patients in having access to actively managed-consultant services".
The 2002 Programme for Government based many of its pledges on the 2001 National Health Strategy which set 10-year targets to 2011. On waiting lists, the promise was that "all persons will be given an appointment for treatment within three months of referral".
Latest figures suggest we are still a long way from this target. The NTPF report of December 2006 stated 15,096 adults were waiting for surgery and 32 per cent of these had been waiting for more than 12 months, 31 per cent for six to 12 months and 37 per cent for three-six months.
The time delays for 2,300 children waiting for surgery are broadly similar. However, by presenting the statistics in a different way, the NTPF states that for the top 20 surgical operations, the average waiting time for adults is two-five months, with the same average waiting time for eight of the 10 top surgical operations for children.
There are also 4,425 adults and 402 children awaiting medical admission - cases where people require hospital admission but not surgery - and 35 per cent of these adults and 27 per cent of children have been waiting more than 12 months. Medical cases are not within the remit of the NTPF.
It is also noted in the report that the fund wrote to 11,379 people waiting for surgery and 8,042 did not respond to the offer of treatment. Of the 3,337 who did reply, 2,656 were found to be eligible for treatment.
To get a true picture of waiting times for services, it must also be borne in mind that there are thousands of people waiting for an outpatient appointment to see a consultant before they even get on these lists. Many of these can wait well in excess of 12 months.
This Government's record on providing medical cards has also been frequently criticised. In its election manifesto in 2002 Fianna Fáil promised an additional 200,000 medical cards but in the Programme for Government no figure was mentioned, only a pledge to extend eligibility was given. In fact, in the first two years of this Government, the number of medical cards fell by 20,000 - down to 1,148,914 by 2004.
In 2004, Minister for Health Mary Harney promised 200,000 GP visit cards - where the patient pays for everything except the GP's fee. Latest HSE figures show that just over 70,000 GP visit cards had been issued and at the end of 2006 there were a total of 1,221,695 medical cards - an increase of just 42,950 since 2002, when the figure was 1,168,745.
Overall then, as compared with 1995 when 35 per cent of the population had medical cards, less than 30 per cent have medical cards now.
After her appointment, Mary Harney made the A&E crisis a priority, setting out a specific plan to deal with it. The HSE says there has been a 62 per cent reduction in emergency department waiting times compared with this time last year and that there has been a similar reduction in the numbers waiting.
It also points to a patient survey it commissioned which found that 79 per cent of patients had an initial assessment within one hour of arrival and that 75 per cent of patients were examined by a doctor within three hours of being assessed.
However, this picture does not tally with the fact that Beaumont Hospital in Dublin - one of the largest in the State - had a record number of patients on trolleys on February 20th this year. A total of 52 patients were waiting in the hospital's A&E unit for a bed that day, prompting a row in the Dáil between Taoiseach Bertie Ahern and Fine Gael leader Enda Kenny.
The Irish Nurses' Organisation put the overall number of patients waiting on trolleys around the State on the morning of February 20th at 392, while the HSE said that by that afternoon the number had fallen to 219.
The crisis in Beaumont in February proved a point made by doctors that a new out-of-hours GP service in north Dublin, D-Doc, which started in December, would not have any significant impact on the problems in A&E as the people waiting on trolleys need admission. The HSE had been arguing that it would help alleviate overcrowding in A&E.
The start of D-Doc did, however, represent a success for Mary Harney in delivering a pledge in the Programme for Government to extend 24-hour GP cover throughout the State.
More than 90 per cent of the State is now covered by such services.
Overall then, in A&E, the Government will argue that it has delivered on its pledge to "significantly reduce waiting times" but many doctors argue that the emphasis on cutting queues in A&E is leading to longer waiting times for elective procedures as more beds are being filled with patients from A&E.
While political parties are arguing over the cost of the additional hospital beds they are promising, the IMO points out that the number of acute hospital beds fell from 17,665 in 1980 to 11,832 in 2000 and says 15,000 such beds are now needed.
Any such calculation would need to take into account the increase in population over recent years. In the 2002 Programme for Government, there was a pledge to increase bed capacity by 3,000 during the 10 years of the 2001 national health strategy.
In a statement, the HSE says 920 additional acute hospital beds have been put in place since 2002. Figures are not available for day service beds, but the HSE says there has been "considerable expansion".
However, Mary Harney said last week that the total bed capacity for both inpatient and day care had increased from 11,727 in 1997 to 13,771 in 2006. She said the rate of increase was 200 a year. At this rate of increase, the 3,000 promised beds would not be delivered for 15 years.
While MRSA was not mentioned in the Programme for Government, the HSE this year set up a national infection control steering group with the aim of reducing MRSA infections by 30 per cent. Latest figures show that in 2006 there were 587 MRSA bloodstream infections, just five fewer than in 2005. Such infections are life-threatening.
In Norway, with a population of 4.6 million, the figure for 2005 was four, and in Denmark it was 11. Very high bed occupancy rates in Irish hospitals, at more than 95 per cent, and a lack of isolation facilities mean it is impossible to tackle the problem in the way most northern European countries do.
A 2003 survey found only 6 per cent of beds in hospitals in the Republic were in single rooms. Britain has now set a five-year target to have half of all patients in single-bed rooms and a bed occupancy rate of 85 per cent to reduce MRSA rates.
Such targets are not even being mentioned here. The HSE points to improvements in hospital hygiene standards as successes in this area.
Mary Harney takes credit for starting these national hygiene audits.
An additional 52 infection control staff were promised last year but none of these has been appointed yet. The HSE says recruitment is under way.
The Programme for Government also pledged a network of primary care teams around the State. A promise of up to 600 by 2011 later changed to 200 by 2007, but, according to Dr Paula Gilvarry of the IMO, no primary care team is fully in place yet. She says that while the Government promised €1.3 billion for the primary care strategy, only about €30 million has been spent to date.
A spokesman for Harney said this week that to date 450 GPs were "involved in the development of teams with a further 700 projected to become involved in 2007".
A pledge was also made to ensure "that people in all parts of the country have reasonable access to cancer services".
Although the Irish Cancer Society acknowledges that there have been significant improvements in services over the past five years it has been calling for the post of director of cancer control to be filled, as recommended in last year's cancer control strategy. While the HSE issued a statement at the end of March announcing that this post was to be advertised after new cancer statistics were released, in a statement this week again it said "it is anticipated that the post of director will be advertised in the coming weeks".
A cancer control advisory committee has been appointed.
While definitions of "reasonable" may vary, it is still the case, and will be under current plans, that cancer patients in Donegal have to travel to either Dublin or Belfast for treatment.
In relation to BreastCheck, women living in the west and south are still denied the service.
A spokesman for Harney lists among her other achievements the abolition of the health boards. However, many believe the establishment of the HSE has to date led to greater bureaucracy and less transparency. Harney receives praise from Sheila O'Connor of Patient Focus for bringing in the 2007 Medical Practitioners Bill, saying she believes it will ensure doctors are more accountable to patients and that Harney has taken seriously the issue of patient safety.
The Department of Health also points out that a new independent nursing home inspectorate is being set up; that a decision was taken on the location of a new national children"s hospital; a new "fairer" system to cover nursing home costs has been introduced and that medical school places have been doubled.