Two years ago, a report* on our health services spoke of the ethical responsibility of government to ensure timely, universal access to the acute system of health care on the basis of clinical need.
The report was highly critical of our two-tier health system, where those with insurance skipped the queue and those with medical cards waited for years for necessary treatment. Election promises were made. A system which provided for the private treatment of public patients, where long delays were involved, was introduced. And a 10-year, innovative health plan was formally adopted.
Last week, following a succession of measures to control costs and employment numbers within the system, only 5 per cent of the electorate believed the Coalition Government had kept its promises to provide better health services. The Irish Times/TNS mrbi opinion poll found that two-thirds of those questioned said it was an issue that would influence their future voting intentions. And the Government's difficulties may worsen. A strike by public health doctors is entering its seventh week. Unions in the health sector are urging the Irish Congress of Trade Unions to ratify an all-out picket in support of their dispute. On top of that, the Government has plans to abolish existing health boards and to replace them with a less cumbersome administrative structure.
There is no doubt that managerial and structural reform is desperately needed. Medical services must be provided in a more efficient and cost-effective way. Providing money, in itself, has not resolved the problem. In the five years to 2002, healthcare spending rose from more than €3 billion to €8 billion. And while the quality of service to the general public improved, the return was not what it should have been.
An indication of that failure came last Thursday, when the Department of Health circulated figures that showed more than 29,000 people on hospital waiting lists at the end of last year. Those statistics will have understated the true problem, as a number of hospitals were excluded from the calculation. More recently, hospital wards were closed in Dublin, and in other cities, in a desperate attempt to save money, and this reduction in the number of beds will have a direct impact on future waiting lists. The Minister for Health, Mr Martin, admitted that the promise made by the Taoiseach, Mr Ahern, to end hospital waiting lists within two years will not be met.
There is a growing militancy among health workers, who anticipate a winter of distress and hostility as services are reduced and patients are treated, in growing numbers, on trolleys in corridors. In order to remain within the employment ceilings set by the Government, some 400 jobs are to be shed in three health board areas. This crude, cash-orientated approach by the Department of Finance will not facilitate an easy transition to a more streamlined, efficient and responsive system. Imagination, flexibility and investment will be required to create a universal system of quality healthcare.
• Correction & Clarifications
The report referred to above was originally wrongly attributed to Harvard University. In fact, the author of this report, entitled "Waiting Lists: Analysis, Evaluation and Recommendations", was Professor Ray Kinsella, director of the Centre for Insurance Studies, Graduate School of Business UCD, and the genesis of the report was a case study developed for and by the Harvard Association of Ireland.