The Minister is upbeat about progress in her department, reports Dr Muiris Houston, Medical Correspondent
One year to the week after she took up the post of Minister for Health, Mary Harney remains upbeat about the job. And she is already looking forward to the next election when she says the PDs will say to the electorate "we've made a big start in health, let's get the job done now".
"By 2007, I expect to have a number of key reforms implemented. The building blocks will also be well in place for the longer term reforms going towards the end of the decade," she says, confirming her desire to return to the Department of Health after the election.
But what does she think she has achieved in the health portfolio to date? She lists the plan for 1,000 additional public beds through private investment, a national radiotherapy network and a fairer means test for medical card eligibility.
"Waiting times for operations for public patients are being reduced rapidly. This year I increased the National Treatment Purchase Fund by 50 per cent. It is making a big difference for waiting times and for fairness for public patients," she says.
What about the 10-point plan for accident and emergency which she announced last autumn? Is it something she is happy with given the still lengthy queues in A&E?
"I think we have made good progress on the plan. We have focused on step-down facilities with flexible packages of home care and home help to allow people to leave hospital when they are medically fit to be discharged.
"We have gone to tender for northside GP out-of-hours services, another element of the plan. The issue of hygiene and cleanliness is being actively addressed and I am awaiting the outcome of an audit of hospital processes which will help improve efficiency," Harney says.
One of her priorities in the coming year will be improved care of the elderly, which she feels will help indirectly with the A&E problem.
"A big focus of mine is to support people who want to live at home. Research in the United States has shown that older people looked after at home live at least two years longer. At the moment, we do not offer enough support to high dependency patients."
She is critical of the fact that, at present, different financial supports are available to older people living in different parts of the country. And she is looking forward to the early report of a group appointed by herself and Séamus Brennan, Minister for Social and Family Affairs, which, among other things, will look at the unrealistic threshold for qualification for nursing home subsidies.
"These haven't been changed since 1993 so that anyone with a home valued above €95,000 cannot qualify for a subsidy. This is ridiculous when the average cost of a second-hand home in Dublin is €402,000. We need to relate subsidies to the person's level of dependency," she says.
Harney is also keen to implement new contracts for both consultants and GPs.
"The consultant common contract is a very confused contract at the moment. We need a new contract that meets the needs of 2005 and beyond. It needs greater clarity and transparency."
What are the key elements she would like to see in a new deal with consultants?
"We need a contract that is less rigid, that monitors what we are getting in the public system, one that's measurable in terms of paying X and getting Y. I would like to see a greater role for education and clinical research as well as a greater role for clinical governance."
The Minister feels that her initiative in providing 1,000 additional private beds on the campuses of public hospitals will lead to greater clarity about "who is doing what, where".
As part of a new contract, she wants consultants to work in teams together so that discharge decisions can be made several times a day. She says a pilot study is already underway in one Dublin hospital into this method of teamwork, which she emphasises is separate from existing multidisciplinary team work in hospitals. And she wants to see a full-time public hospital work option in the new contract.
The Minister says she is committed to increasing the number of doctors in training to meet the demand for extra GPs and consultants and that concrete proposals will appear in the upcoming Budget estimates.
"We need to seriously increase the number of medical students. I have been told that if we double the number of places for Irish students, the points for medicine will fall from 600 to 575.
"In addition, we need graduate entry so that everyone is not making a decision to enter medical school at 17."
Asked if a new graduate school would be part of an existing medical school, she said there were arguments for and against. But she refused to be drawn on whether Limerick University would be approved as the State's first graduate medical school.
Will primary care be a greater priority for next year? "Within primary and community care there is a need to bring existing resources together at a local level. At the moment, we have several different professionals intervening with the same person and yet the mechanism isn't there for them to link together."
She sees the GP as having a big role to play and a new GP contract is important to copperfasten that role.
"And in disadvantaged areas I am particularly concerned to ensure that we fund general practice. In parts of Dublin's north and south inner city I am told many GPs are in their mid- to late-50s with no young people coming into this kind of practice."
But is she committed to the Primary Care Strategy?
"Yes, I am, but at the original funding level it's not going to happen. But if methods of private funding are put to me, I am interested in hearing proposals."
Harney does not rule out groups other than family doctors running general practice as is happening in Mulhuddart, where she says she is looking forward to opening a primary care facility developed by Touchstone Ltd in the coming weeks.
She is adamant that GPs will not benefit from benchmarking if the Irish Medical Organisation does not agree to implement the doctor-only medical cards.
"A decision will have to be reached by the end of this week. I have asked the department to look at other ways of funding this if the doctors do not agree."
What about the 30,000 additional regular medical cards she promised?
"They are happening. New cards have been issued all year."
But she says the uptake on the new cards has been very low and concedes there is a need for a publicity campaign so that the public understands that eligibility is now based on disposable income.
Another contract due for renewal is that between the pharmaceutical industry and the Department of Health on the cost of the State's drug bill. "We need better value for money and a greater use of generic drugs," the Minister says.
How will this be achieved? "Well, there is no question of doctors losing their clinical autonomy by making them prescribe generics. I think we can use money to bring about greater generic use. It may be a system where the State pays for the generic drug and the balance is paid for by the patient."
When will the long-delayed Medical Practitioners Act be published?
"Early next year. It is a mammoth piece of legislation," she says.
But she does confirm there will be more public than professional representatives on the next Medical Council. "This is what the public interest requires. I also want the council to have more proactive powers and its competence assurance functions to be strengthened."
But where will the additional 1,000 hospital beds to be built by the private sector on the grounds of public hospitals be located.
"There is strong interest in Limerick, Waterford, Sligo and among some Dublin hospitals. You will see a good geographic spread which is important because of the spread of people with health insurance around the country. But this is specifically about creating capacity in the public hospital system.
"If there is anything I have learned in the last year it is that the pace of healthcare reform is very slow. We have to up the pace. It is not satisfactory from the patients' perspective. Now that we have a very dynamic new chief executive for the HSE [Dr Brendan Drumm] and the final pieces of the HSE are put to bed and the responsibility clear as to the department and the HSE, I expect things to move forward."