With two major reports on the health service entering the public domain in the past number of weeks, it is evident that a new phase in the battle to save our ailing health system has begun.
The Prospectus audit, commissioned by the Department of Health and the Brennan Commission study, commissioned by the Department of Finance, are in-depth analyses of the health service. And while clearly driven from different political standpoints, there is some overlap in the conclusions each has reached.
The health board structure looks set for change. Indeed the Brennan Commission makes it clear that it could not support a revamping of health structures unless the Eastern Regional Health Authority is subsumed into a new health service executive and there is a significant reduction in the overall number of health boards. Prospectus is more specific: a national health service executive should have four regional structures with greater consumer and professional representation at the expense of local politicians. Both reports recommend a considerable reduction in the number of independent agencies currently involved in the supervision and delivery of healthcare.
But the Brennan Commission has been far more surgical in both its analysis and its recommendations. Dominated by financial experts, it has focused on the structural deficiencies which exist in every health sector. It is evident from the language of its report that it was shocked at both the prevalence and the extent of the financial mismanagement it uncovered. While Professor Brennan and her colleagues are correct in their recommendation that all costs incurred by the health service should be allocated to individual patients, it will require a fundamental rebuilding of the health system for this to occur in practice. Giving financial accountability and responsibility to individual hospital consultants is a clever move; however, it might be even better to give such responsibility to clinical teams, representing nurses and therapists as well as doctors.
Although primary health care was endowed with a separate national strategy in November 2001, the reference to it in the Brennan report is curiously negative. Expressing concern that the medical card scheme represents "one of the biggest challenges and financial risks to the health service nationally" seems an excessively alarmist analysis of a structure which provides 24-hour care to one third of the population for less than 12 per cent of health service expenditure.
It is important that both the Prospectus and Brennan Reports be formally published.The fundamental changes they recommend will take years to take effect. It is therefore essential that they are acted on in a pro-active way by the Minister for Health, regardless of the sectional interests who may seek to delay affirmative action.