A period of industrial unrest within the health services seems to be imminent. Responses from various medical interests to proposals for reform and the introduction of new schemes have been, at best, cautious and grudging; at worst, downright militant.
The Government appears to be concentrating its efforts on containing expenditure. Responsibility for cutting staff numbers while, at the same time, reorganising services has been transferred to a new Health Service Executive (HSE).
Publication of the HSE's first national service plan brought predictable criticism last week as it outlined its priorities for reform, while abiding by Government directives on spending and employment levels. Still without a chief executive, the HSE has been struggling to change the traditional system of medical service funding. But, three months into the financial year, it was unable to say precisely how funds would be allocated between various hospitals and services in each region. Not good enough.
Three years ago, the Government accepted a report that identified the need for 3,000 extra acute hospital beds - only 700 beds have been provided and the population is still growing. One of the consequences of that failure is overcrowded A&E services and the treatment of seriously ill patients on trolleys. With the level of funding now being provided, the HSE says it will only be able to maintain services at last year's level.
A directive by the Tánaiste and Minister for Health, Mary Harney, to reduce staffing levels by 600 in 2005 has generated considerable concern. The HSE has insisted the job cuts will not affect front-line medical staff but it has failed to convince the Irish Nurses' Organisation and the Irish Medical Organisation that hospital and community services will not deteriorate as a consequence.
The need for reform of the health services is absolutely vital. But, after years of studies, reports and political promises, confidence in this Government's ability to deliver has worn thin. The Hanly report, which was to have provided an efficient, regional hospital service, based on extra consultants, has been quietly binned. Negotiations on a common contract for consultants have been seriously delayed. And general practitioners are refusing to operate a new, limited, medical card scheme for low-income families.
In all of this, the Minister's priority appears to be control of spending and, almost as a by-product, private healthcare is being promoted. The HSE has been given grave responsibilities for running the health services and for providing quality care. But it must not be made into a whipping boy for Government failures.