The Minister for Health, Mr Martin, has categorised as "outrageous" claims by local groups that their hospitals will be downgraded and services closed under the administrative reforms contained in the Hanly report. The Minister's annoyance is understandable, particularly as the thrust of the report envisages an improvement of services on a regional basis, through the employment of teams of consultants and the injection of extra funding.
But, if the Government finds itself vulnerable to local concerns on this issue, it has only itself to blame. Services in accident and emergency wards are already so inadequate, because of overcrowding and lack of resources, that people are prepared to believe the worst. They understand only too well what a reduction in services entails, while they are dubious about promised reforms.
Given the susceptibilities of communities and their fierce attachment to local hospitals, it was an error to recommend the closing of all accident and emergency services in peripheral hospitals between 8 p.m. and 8 a.m. No matter that a broader range of elective medical and surgical procedures would have been provided by consultants visiting from the regional centre, a perceived down-grading of local services became the issue. A more effective solution might be found through the creation of medical and surgical assessment units, such as exist in Kilkenny, along with limited overnight medical cover.
Hospitals enjoy a high profile in Irish politics. A number of single-issue hospital candidates were elected to Dáil Éireann in recent years. And the Minister for Defence, Mr Smith, acknowledged the strength of local passion in Nenagh last year when he spoke against Government policy and the Hanly report.
Public protests over a reduction in accident and emergency services at Nenagh, Ennis and a number of other small hospitals have since led to the establishment of a national organisation. The opposition parties are centrally involved in that development. And Labour senator Ms Kathleen O'Meara is spokeswoman for the steering group. But the issue is so inflammatory, in the run-up to the local authority elections in June, that Fianna Fáil councillors have also participated.
Some of the reforms of the Hanly report are driven by a need to reduce the working hours of so-called "junior doctors" by next August, in order to comply with EU law. In parallel with that, the number of hospital consultants will more than double over a 10-year period and new services and working procedures will be put in place.
The reforms look good on paper. But a lack of political will could prevent their implementation. Opponents of the scheme say the Government has yet to fund and open some 3,000 acute hospital beds it accepts are required. Without those beds, they argue, it would make matters worse to crowd patients into regional centres. And they are equally critical of a failure to invest in ambulance services. The Government must deal with these issues or the public will remain unconvinced.