The more things change the more things stay the same. So it is with the health service as it faces into another challenging year. Emergency departments continue to show the strain, albeit with an ominous development in one of Dublin's premier teaching hospitals: on several occasions during December Beaumont hospital appealed for people to stay away from its emergency unit while simultaneously going "off call" for the emergency ambulance service in North Dublin. With elective operations also cancelled the hospital effectively closed down to new patients – a worrying and unprecedented occurrence. Despite different initiatives from various Ministers for Health, the emergency department bottleneck continues. The reason is obvious: a combination of too few acute hospital beds and the absence of surge capacity during the winter period and a continuing shortage of appropriate facilities for patients who have completed their acute phase of treatment and now require rehabilitation or extended long-term care.
Leo Varadkar, who took up the reins at the Department of Health during the year, is not making any promises of a quick remedy, despite securing an additional €27 million for the health budget. This is on top of a supplementary estimate to cover the 2014 shortfall, indicating that for health at least the severe pruning of previous austerity budgets has come to an end.
The Minister was in the happy position of being able to clear up a politically damaging mess left by his predecessor. The ill thought-out medical card probity exercise, which left vulnerable people unable to access free medical care and drugs, damaged both Government parties in the local elections. Following an extensive review, all cancelled discretionary medical cards have now been returned to recipients, with a promise of a more sensitive local application process.
It is likely the limitations of our abortion legislation will continue to be exposed in 2015. The Y case, where a young asylum seeker with an unwanted pregnancy reluctantly underwent a Caesarean section, and the case of the brain dead woman who was 16 weeks pregnant but whose parents’ wishes for her life-support to be switched off were challenged by the State, were low points in 2014. The latter case illustrated how such rare and difficult situations are best resolved by sensitive ethical medical practice.
Will 2015 be the year when free GP care for children under six will finally be put in place? Amid signs of some rapprochement between the new Minister and doctors representative organisations, a formula for the scheme’s introduction is likely to emerge. From a political perspective, it may be the only concrete move to a system of universal healthcare prior to the next election, something promised amid great fanfare when the Government took office.