HEART BEAT:Mary, Mary, what have you done, asks Maurice Neligan
WE HAVE a little change on our political landscape. Owing to the demise of her party, our Minister for Health, Mary Harney, is now left swinging gently in the breeze.
Presumably, her position in the Cabinet is as an independent, yet she is responsible for a health budget exceeding €16 billion. She has made it clear that she would wish to retain this portfolio.
Quixotically, she states that this is because she wants to continue her reform of the health service and, even more astoundingly, claims that progress has been made.
This astonishing assertion was made at the opening of yet another private clinic, the VHI Swiftcare clinic in Cork. The same Cork where a custom- built state-of-the-art AE department in the Mercy Hospital was left idle for two years because the HSE would not sanction the staff to run it.
But this is different, this is private. No matter that it won't be a 24-hour operation, or that anything serious will have to be shipped onwards to a public hospital.
Such clinics exist to provide an escape hatch for the insured and particularly the more articulate members of society to avoid exposure to the world of the trolley, the chair, the corridor and the perpetual overcrowding, presided over by this Minister who wants to be left in the job.
I, myself, heard the lady say that foremost among her achievements was the establishment of a lay majority on the medical council. Big deal there Minister; what possible significance can that have for the sick and disadvantaged?
How will that move patients from trolleys into beds? How will that open closed wards and restore services eliminated in an attempt to impose artificial fiscal rectitude on that most basic human endeavour, the care of the sick?
You've got it wrong all along the line, Minister. You talked the talk but you did not walk the walk. You did not listen to those providing the service or figure alternatives to your improbable visions of the future.
We'll never see it your way because the money has run out. What chance now the thousands of new consultants at €250,000 each not counting their support staff?
What chance now extended working days with outpatient and ancillary staff working additional hours? Even the admirable primary care strategy must face the financial reality of the time.
In dealing with all aspects of the caring professions you did not understand that caring, compassion and concern was their "vested interest". Your initial contract offered to the consultants tried to gag their right to advocate for their patients.
Layers of stifling bureaucracy in the HSE served to stifle dissent and repeatedly misrepresent the problems on the ground. We heard there were no cutbacks in frontline services when in truth both in hospital and community care they were widespread and indiscriminate.
When cornered, the response was X institution will have to live within its financial allocation. If that meant, as it invariably did, that patients had to suffer; well that was just too bad.
The Taoiseach defended your decision to scrap the cervical cancer vaccine and told the leader of the Opposition that the screening programme would in fact be more efficacious in the long-term treatment of the condition.
He did not mention that the cytology involved in such a programme had now to be sent outside the State and the expertise and employment here had been abandoned for fiscal reasons. It also happens that he was plain wrong.
Prevention is always better than cure, a basic axiom of medicine. He was right though that you took on what he conceived to be the "vested interests".
Bluster, belligerence and bravado carried the day over compassion and caring, and all the nurses, doctors, pharmacists and paramedics were out of step, all except our Minister.
The medical card debacle was another issue. Backtrack, U-turn, call it what you will. The irony is that when the dust settles there will be no €100 million saving. There may well be none at all.
We are told that the face- saving exercise abandoning the millionaires and, of course, judges and hospital consultants (did I hear politicians?) would affect just 5 per cent of the population. Well, it is more likely that it is 15-20 per cent.
Furthermore, the generous €35,000 cut-off for the "single" person does not state that of course many such at that age are widows or widowers and that it is their pension you are talking about. For many, I might add, their declining pension.
They worried about the costs of residential care which might swallow everything they had. They needn't have worried, because you had an answer to that also. Simply take it from their already devalued estates on their death.
The first bastion of universality in the treatment of our senior citizens is down. Free travel, television licence, phone rental - what's next? You have said that's the lot. Why should they believe you?
Certainty is a difficult concept to address. Most of us doubt a little, most of us learn a little. Oliver Cromwell's words to the Kirk in Scotland in 1650 might well have been meant for you Minister; "I beseech you in the bowels of Christ think it possible that you may be mistaken?"
• Maurice Neligan is a cardiac surgeon