It was yet another tumultuous year for health services in the Republic, writes Dr Muiris Houston, Medical Correspondent
A ban on smoking in the workplace was introduced in March by the then Minister for Health, Mr Martin. Although widely opposed by the vintners and drinks industry, nine months later, compliance is running at 97 per cent and the move has won the support of the majority of people in the State. This move was the health highlight of 2004.
A new Minister for Health took up office in September. The much-awaited reform of the health service stuttered and stumbled to year end. Meanwhile, the Irish public finally rose up against the inhuman conditions faced by patients in hospital A&E departments.
Hospital consultants drew back from strike action but are likely to reactivate their campaign early next year. And the first ever indigenous case of vCJD in the State was identified in the autumn.
Early in the year, the infamous Hanly report came in for more criticism. A detailed critique of the report from Dr John Barton, a consultant physician at Portiuncula Hospital in Ballinasloe, Co Galway, and Catherine McNamara, a health economist, described it as being "intellectually dishonest".
The grim reality of public healthcare in a deprived urban area was highlighted by this newspaper when it was contacted in March by GPs in Ballymun. The main health centre in the area had been closed on health and safety grounds. A 35-year-old woman with acute asthma was unable to complete emergency treatment with drugs given by inhaled nebuliser because of a power failure.
What was particularly galling was the existence of a replacement, purpose-built, health centre which still remains empty because of a disagreement between the Department of Health and the local health board over funding.
Billy Burke, the cystic fibrosis sufferer who died last month, hit the news in April, when he became the centre of a dispute between two UK hospitals over his suitability for a lung transplant. In the meantime, the Republic's lung transplant unit at the Mater Hospital has yet to perform its first operation.
The row over medical insurance cover waxed and waned throughout the year. The Irish Hospitals Consultants Association (IHCA) voted for industrial action for the first time in its history in February. It halted the action in its early stages, following an intervention by Mr Martin. But the problem of who was responsible for the liabilities of Irish consultants prior to the introduction of State liability would not go away.
The Medical Defence Union (MDU), a British insurer, eventually refused to offer assistance to 16 doctors, most of them obstetricians, even though they had paid subscriptions to it.
The MDU argued the State should take responsibility for past liabilities now that it had set up the State Claims Agency. Its counterpart, the Medical Protection Society (MPS), accused it of "holding a gun to the head of both the Department of Health and the medical profession", a view that was vigorously rejected by the MDU.
As the year ends, the long drawn-out dispute looks set to be a major catalyst for a strike by consultants next February. Both the Irish Medical Organisation (IMO) and the IHCA will co-ordinate ballots on strike action.
Meanwhile, a major report by the Public Health Alliance of Ireland (PHAI) highlighted how little difference the Celtic Tiger has made to the health of the poor in the Republic.
The inequities of health here mean that death rates among poor people are more than three times higher than among the richest. Male suicide occurs at a much higher rate in lower socio-economic groups. Death from lung cancer is four times greater for people in the lowest occupational class while death from stroke is three times greater.
"In no other area is the impact of inequality on society as devastating as it is on our health," the report noted.
Patient care at Cavan General Hospital came under intense scrutiny following the suspension of two of its consultant surgeons and the death of Frances Sheridan for an obstructed bowel some three weeks after an appendix operation there.
One of the biggest studies into what causes heart disease was published at the European Society of Cardiology congress in August. It found that two most important risk factors for heart disease was smoking and high cholesterol. Additional risk factors identified by the research were: high blood pressure, diabetes, abdominal obesity and stress. Daily consumption of fruit and vegetables, daily exercise and a low alcohol intake were found to protect against heart attack.
There was some good news from the National Cancer Registry in its latest report. It found that more patients are surviving cancer than ever before. There was a particular jump in the percentage of men alive five years after cancer diagnosis. On the downside, there was a slight increase in cancers associated with obesity, which is itself on the increase.
Mary Harney became Minister for Health in September. Confirming she had sought out the job, she indicated she hoped to bring about change in a number of targeted areas. A&E was one. But it rose up to bite her before she had an opportunity to table any proposals on the issue. Rising numbers of people waiting on trolleys for days for inpatient beds dominated headlines. As the number on floors in casualty hit the airwaves and newspapers, the public finally revolted.
An action group was formed and it organised a series of marches in Dublin to highlight the desperation of the (mainly) older people who find themselves at the raw end of the hospital bottleneck.
Ms Harney brought in a 10-point plan to deal with A&E as part of the Health Estimates. She also tackled resource issues for the disabled, with a promise of 1,000 additional front line staff.
Legislation to establish the new Health Service Executive (HSE) was rushed through the Oireachtas, and the 2004 Health Act will be law by January 1st. But the biggest setback in the entire reform process was the decision by Prof Aidan Halligan, chief executive designate of the HSE, not to take up the post.
One of the biggest challenges for the health service will be how to tackle the growing problem of MRSA infection in Irish hospitals. Up to 10,000 people are now carrying the bug with more than 400 cases of serious and even fatal illness the result. The Republic has the second-highest rate of MRSA in Europe, so urgent action will be needed.
There is never a dull moment where health issues are concerned and 2004 was no exception - 2005 will probably be even more turbulent.