Muiris Houston, Medical Correspondent, explains why the Hanly report has been quietly buried.
Hanly is dead, long live Hanly. While the respected management consultant, Mr David Hanly, is very much alive and well, the crucial report into the future of the health services which bears his name has just been quietly buried.
The decision by the Tánaiste and Minister for Health, Ms Harney, not to renew Mr Hanly's contract with the Department of Health, allied to the disbandment of the National Task Force on Medical Staffing, the group chaired by David Hanly, marks the end of a key Government response to the 2001 National Health Strategy.
Established in February 2002 by the previous minister for health, Mr Martin, the expressed purpose of the Hanly task force was to devise a plan to reduce the working hours of non-consultant hospital doctors (NCHDs) to meet the requirements of the EU Working Time Directive.
However, the work of the Hanly group quickly became much more than this: along with the Prospectus and Brennan reports, it formed the three planks of health service reform. And despite its title, which at first glance suggests a relatively narrow remit, Hanly quickly moved to the cutting edge of reform.
The main reason for this was that, to reduce NCHD working hours, David Hanly and his fellow task force members were obliged, according to the group's terms of reference, "to devise, cost and promote the implementation of a new model of hospital service delivery . . . with the highest quality service, using available resources as equitably, efficiently and effectively as possible".
To the task force's credit, it did not deviate from those politically sensitive reference points. Implementing a new model of hospital service in an equitable, efficient and effective manner was always going to bring the group up against entrenched health service interests and the sensitivities of local communities.
So what conclusions did it reach? It advocated the employment of "substantially more" consultants. Crucially, in the context of how it was received, it called for the delivery of acute hospital services by an integrated network of hospitals "serving populations of about 350,000 people".
And the task force said that acute hospitals must be restructured "to allow for the safe provision of emergency and elective care".
The Hanly report pushed for a speedy implementation of its proposals: it asked that a Hanly 2 group be formed to work out national recommendations at the same time as the specific proposals for two pilot areas, the Mid-Western Health Board and East Area Health Board, were put in place.
So why did Hanly fall from the apex of Government health reform to its quiet abandonment by Ms Harney? Probably the single biggest reason was the failure to "sell" Hanly to the public and the healthcare professions.
One of the report's own recommendations stated: "there should be a proactive communications programme to educate healthcare staff, public representatives, the public generally and the media as to why the changes it (the task force) proposes are required".
This simply and inexplicably never happened. Instead, Mr Hanly and a few key members of the group found themselves under sustained attack at both public and private meetings throughout the country. Action groups sprang up to defend local hospitals that were perceived to be under threat.
In tandem with local political action, influential hospital consultants such as Dr Christine O'Malley of Nenagh and Dr John Barton of Portiuncula Hospital in Ballinasloe drew up a response to Hanly, which argued in detail against many of the task force recommendations. This in turn gave scientific ammunition to the various local lobby groups which had by then formed an anti-Hanly alliance.
Such was the power of those groups that the former minister for defence and Fine Fáil TD for Tipperary North, Mr Michael Smith, controversially questioned the ramifications of the Hanly proposals. The response to the Hanly report was a strong reminder that all politics is local. Micheál Martin read the signs and gradually Hanly became a dirty word in the Department of Health and in Government generally.
Although a couple of key medical members of the task force continued to argue the case for Hanly-based reforms, by and large the medical profession sang dumb. The Irish Hospital Consultants Association's ban on consultant interaction with the task force, as part of an industrial dispute, was significant.
At the same time even its sternest critics said the reform made sense for the provision of surgical services in the Republic. There is overwhelming scientific evidence that greater volumes of surgery in larger centres lead to better and safer outcomes for patients.
Hanly was never going to improve services for the majority of patients presenting to local hospitals with medical conditions such as pneumonia and heart failure. But it does have some merit, so we can expect the report's ideas will be kept alive by the National Hospitals Office, albeit under a different guise.
And while Ms Harney may have said goodbye to Mr Hanly, watch out for the resurrection of some of his group's recommendations as the Tánaiste puts her own stamp on health service reform.