On fire brigade frontline

Political Editor Harry McGee interviews Health Minister Micheál Martin.

They are walking along the street, Micheál Martin and the reporter. The interview is over. Just before they part, Martin turns around and says: "We never got to talk about the smoking ban."

The reporter waves his hand dismissively and speaks with a certainty that he will soon sorely regret.

"Ah sure, there was no need," he pontificates. "The smoking ban has been played out. It's history."

It's just 4.30pm. One hour and thirty one minutes later, Jim Fahy is beaming pictures to the nation of three Polish students puffing away in a public house in Galway City.

To err is to be human after all. And the reporter is in good company.

There are few Cabinet members who have had to embrace that human reality more than Micheál Martin in his four years as Minister for Health.

Earlier during the interview, the minister had given a treatise (everything he says is always dense with detail) of how attempts to deal strategically with the major health issues are invariably interrupted by what he describes as "the fire brigade role".

"The fire brigade role is constant. An event will happen somewhere and the entire week will be taken up with dealing with and managing that."

And this week's unexpected sequel to the smoking ban saga was a perfect example of that. Everything else including the Dáil debate on the shortcomings of the Government's health strategy was relegated to second place. At least on this issue, Martin was on safe (and high moral) ground. The action of the publican, he railed, was "an affront to the Irish people".

You couldn't help thinking though that this final week of the Dáil before the summer recess is the last week that Micheál Martin will take flak from across the floor as Minister for Health. The Cork South Central deputy has been in charge of what Brian Cowen dubbed 'Angola' for four years now. Come September, it's widely expected he will move on.

He is very careful about how he broaches this: "I am reluctant to say anything that will constrain, or influence, the way that the Taoiseach is thinking. I will obviously discuss the matter with him," he says.

However, he continues with several telling statements that leave the strong impression that he believes the time has come for change.

"It was he (Mr Ahern) who asked me to take the health job in the reshuffle of 2000. I have always been conscious that it is not the most popular place to be in terms of a political career. I have stuck with it in an effort to change the system around.

"On average, over the past 10 to 15 years, the average tenure (of a minister) has been two years."

He has been there for four. He says that the major reform and the biggest re-organisation of the health service for 30 years is underway. That, he says, has been a mammoth task. Adding that there will be obvious "transition difficulties arising out of that", you sense that, from his perspective, a Rubicon has been crossed and that the transition period will be the responsibility of somebody else.

So, what has been achieved in four years? "There are far more people utilising the health services, a quarter of a million more," he replies. "The major changes have been in the quality of cancer care and heart care (two of the biggest killers in Ireland). We have put a lot of money into them."

All hospitals now have a cardiac rehabilitation programme, and that the amount of cancer and cardiology procedures have increased hugely.

In his rapid-fire manner, he gives many other examples. More training places in deficit areas like physiotherapy, occupational therapy, language therapy; plus the 'transformation' that has taken place in nurse education.

"There have been seismic shifts in terms of what is happening on the ground in those areas. The success of the Purchase Treatment Fund has genuinely meant lesser waiting time for patients. The next 12 months will copperfasten that."

Then there are the bigger, controversial, structural issues.

Martin's bottom line for the template of the health services is this: "I would argue that there is a fundamental need for a consultant-led service and that is the cornerstone of the Hanly Report recommendations.

"It's more than A&E. It's moving from a situation where we are too dependent on junior doctors to a situation where we have more consultants."

However, that shift, like all others in health, has been the subject of much contention, including accusations that Martin has not held the line on Hanly. There is the problem of local opposition to any change in status of the local hospital. There is also the row with consultants over their future role and contracts (medical indemnity insurance is the current stumbler).

"We are not talking about ramming every last line of a document down people's throats," he says of local implementation. "I think we need to listen to what people on the ground are saying. We need to analyse their concerns and then meet their concerns.

"Providing the consultant-led service is the big picture. We cannot allow that objective to be derailed by (local) issues that can be dealt with by imagination and creativity."

Much of the minister's political problems of late have stemmed from budgets and employee levels being pegged back over the past two years.

Much of the billion euro extra that was allocated in 2003 was soaked up by benchmarking and price inflation for medicines. The restraints have meant that hospital wards, newly built, have not been opened, something on which the opposition have hammered the Coalition. Lofty promises made in the Programme for Government (in relation to waiting lists, provision of more hospital beds, and an increase in medical cards) also remain embarrassingly unfulfilled.

The criticisms have included snipes from senior colleagues like Mary Harney and Charlie McCreevy who have, in a roundabout way, questioned his handling of his budgets.

"Unfortunately, people fall back on the usual refrain," he responds. "Oh, it's a black hole, why throw any more at it?

"It's not a black hole I always get wary of that argument, because I think a lot of the money we have spent has produced results in terms of extra activity levels.

"Over the last two years, funding was pegged to 2002 levels. Yet, hospitals year-on-year managed to produce a 4% increase in activity levels."

In relation to the new units, he says he is confident that the issue will be addressed sooner rather than later, but will not commit himself to a date.

He follows with a more general point. That the population is aging. That more people will live longer, ergo, more people will need to access health services. That more services will be available to more people.

And this will cost money.

"I accept we need reform. I accept we need better value for money. I would equally argue that given the demographics and the aging issue and changing technologies, that increased expenditure on health will be inevitable," he says.

Does that mean he favours more taxes? No, he says. But something will have to be done.

"We are not as advanced as other countries in terms of the elderly. We either need to put something aside, like the 1% of GDP for pensions or we have to look at individualised packages, to give options to people, perhaps with tax relief."

He concedes that the commitments in the Programme for Government may have been over-optimistic.

"I think the wording of the waiting list commitment left a lot to be desired. On the other hand, if we did not put down our ambitions we could have wallowed on in complacency."

Moreover, the failure to extend medical cards to more low-income families, he says, is a "regret" and a "disappointment". "The current income threshold is too low. I would acknowledge that. You see it when you knock on the doors and meet people who have (encountered real hardship). Clearly the time has come for us to implement that commitment in the manifesto," he says.

Assessing Fianna Fáil's poor performance in the local elections, Martin places himself firmly on the left.

"I do think that we have got a warning that we need to re-galvanise ourselves in terms of looking at our policies. [We need to] align those policies to the less-well off and to places where the Celtic Tiger has not been as manifest."

He makes the observation that Bertie Ahern's response to the 'hit' demonstrated that he is "up to the challenge. I think he's going to concentrate in a very single-minded way in terms of refocusing the Government's strategy".

And what of his own alleged single-minded leadership ambitions?

He responds by saying that this is a creation of others (mainly the media).

"Bertie Ahern, when he became leader, did two things. He ended a lot of the traditional divides that were in Fianna Fáil. You have not had the same sense of people putting themselves forward or creating cabals or platforms for leadership.

"As far as I am concerned, it's just not an issue for me. There's a reshuffle in September and my primary focus is on that," he says.