2004 has been another difficult year for health and the health services. But a clear highlight was the introduction of a ban on smoking in the workplace by the then minister for health, Mr Martin. The initiative will see him going down in history as the first Minister to introduce a national smoking ban anywhere in the world.
A row over medical insurance cover continued throughout the year and is set to dominate the health agenda in the early part of 2005. At issue is who is responsible for the past liabilities of Irish consultants. Both the Irish Medical Organisation and the Irish Hospital Consultants Association are readying their members for strike action in February. The failure of the Department of Health and the Medical Defence Union to resolve the issue, notwithstanding the Minister for Health, Ms Harney's guarantee that neither patients nor consultants would be left exposed, means that relations between the minister and consultants remain tense.
Not alone must Ms Harney resolve this matter, she also needs to secure the agreement of consultants on a new contract that will allow the recruitment of up to 1,000 senior doctors. Additional consultants are necessary if health service reform is to progress.
This year saw the biggest restructuring of the health service since the 1960s, with the introduction of a new Health Act. From next Friday the newly formed Health Service Executive (HSE) will assume responsibility for all operational aspects of the health system. The Department of Health will focus on policy and planning issues. And although health board structures are to remain in place for the next six months, they will gradually be dismantled as the HSE assumes greater power.
For many individual patients 2004 was not a good one. Mr Billy Burke, the brave cystic fibrosis sufferer, died without receiving the lung transplant he sought. Older patients spent days on hospital trolleys in over-stretched accident and emergency departments. Campaigners took to the streets to protest against the inhumane conditions.
The year ended with the referral of the Health Amendment Act to the Supreme Court by the President. The issue of who should pay for public nursing home care goes back to a decision made in 1976 by the then minister, Mr Corish, but the controversy has also rekindled a debate about the 2001 move by this Government to offer medical cards to everyone over the age of 70. By the Tánaiste's own admission the Cabinet decision may have been made without a full awareness of the cost implications or numbers involved. All concerned should appreciate the clarity offered by the Supreme Court review.