Promises prove to be empty
A HEALTH system that supports and empowers you, your family and community to achieve your full health potential.
A health system that is there when you need it, that is fair and that you can trust.
A health system that encourages you to have your say, listens to you and ensures your views are taken into account.
Such was the vision of the National Health Strategy, launched amid much fanfare, brouhaha and glossy design in November 2001 six months before the last General Election.
Big on aspiration, low on implementation. In today's chaotic health climate, its promises would be risible but for the fact the health of the nation is not a laughing matter. Taoiseach Bertie Ahern vowed the strategy would deliver "major improvements in services throughout the country".
Health Minister Micheál Martin said it would "immediately benefit substantial numbers of our people ... and contribute to the construction of a health system which, in little more than half a decade, will be immeasurably improved and visibly different".
It was based on principles of equity, people-centredness, quality and accountability. It promised better health for everyone and responsive and appropriate care delivery.
A year down the line, what has this highly aspirational strategy managed to deliver on? One of its key promises, of 3,000 additional acute hospital beds by 2011, is already on the back burner. By the end of 2002, around 300 new beds had come on line, but any benefits from this were wiped out with one swift stroke yesterday when Dublin's five leading hospitals announced 250 upcoming bed closures due to budgetary constraints.
It promised extra beds but with no extra nursing staff at a time when the country's hospitals are cutting back on overtime, not filling nursing vacancies and putting caps on recruitment.
It promised to reduce waiting lists and cut waiting times and some success was achieved by treating patients under the National Treatment Purchase Fund (NTPF). By the end of March this year, 3,340 patients had been treated under the NTPF.
However, in the absence of new waiting list figures from the Department of Health, it is impossible to assess how effective it has been in slashing waiting lists. A decision by five Dublin hospitals to reduce patient admissions by 14,000 this year is hardly likely to have a positive effect.
It promised improved services for the intellectually disabled, before the Government turned on its heel this year and said, sorry, no money for new care places.
It promised the extension of GP co-ops on a national basis, but yesterday a spokesman for the Irish College of General Practitioners (ICGP), scoffed at efforts to date.
"People are increasingly frustrated that they are being denied a useful and relatively inexpensive service. GPs are refusing to take up work in areas where co-ops are not up and running. They are not prepared to be on 24-hour call one day in three any longer. We are losing them in droves to Britain. GP co-op cover only extends to 30% of the population," ICGP spokesman Dr Brendan O'Shea said.
And so we have arrived a point where it can be said, without too much fear of overstatement, that the health service is terminally ill.
We have up to 300 public health doctors on strike this past month because a nine-year-old agreement promising pay for out-of-hours monitoring of infectious diseases has not been honoured.
We have a Health Minister whose remarks, accusing the public health doctors of "total abandonment of responsibility", have infuriated the medical profession so much that consultants and junior doctors are drawing up plans to join the public health doctor strike.
The strike coincides with the emergence of the SARS virus, one of seven pathogens with the potential to cause the next Black Death, according to the World Health Organisation.
We have militant nurses threatening strike if hospitals go ahead with staff cuts, if rostering isn't improved or due to understaffing and overcrowding at the country's A&E departments.
We have endless callers to radio stations telling tales of elderly people on A&E trolleys five days in a row with no hope of a bed, waiting for an overworked consultant to see them.
Then there was yesterday's announcement, from Dublin's five leading hospitals, the seriousness of which cannot be underestimated.
It will mean 250 bed closures. There are already 350 beds occupied by long-term care patients, who should be in nursing homes, rehab or community care. Together, this means 600 beds are lost to the system the equivalent of a large hospital, or a 20% stock reduction.
These bed closures have a knock-on effect on A&E admissions. Scheduled operations will be curtailed, so some patients will not have their medical conditions diagnosed in time. Doctors warn of delays in necessary operations (such as cancer surgery and major cardio-vascular treatment) and in the treatment of the sick, causing unnecessary suffering. Delays in getting treatment for injuries could lead to people suffering disability, deformity and pain, doctors warn.
There will be up to 14,000 fewer admissions, cutbacks on drug purchases and in the maintenance and replacement of essential equipment. And all due to a shortfall in Government funding.
A statement from the Eastern Regional Health Authority (ERHA), which funds the five hospitals, said it was spending €872m buying services for the five Dublin hospitals this year, compared to €871.2m last year, but less additional money is available in 2003. It said the shortfall had to be seen in the context of unprecedented investment in hospitals in the East over the last three years, allowing for the treatment of more than 23,000 extra patients in the last two years.
It also said it would work with the DATHs (Dublin Academic Teaching Hospitals) to ensure patients were prioritised on the basis of clinical need, that the impact on them be minimised and that it was planning to increase the number of step-down beds to free up hospital beds.
Yesterday, Mr Martin attended a meeting of EU health ministers in Brussels to discuss the SARS threat. His spokesperson said the minister was unavailable for comment.
In the face of growing cutbacks and denied access to treatment, people's lives are at stake. And with the Department of Finance holding a tight rein, a cure for the ailing system seems more and more remote.
