Martin faces date with destiny

MICHEÁL MARTIN does not want to spend the rest of his political career running around the country like a firefighter putting out bush fires.

That is what the health minister has spent the last two years doing every time a crisis has erupted with some patient, hospital or health board.

The litany of crises Mr Martin was called on personally to tackle in the past three months bear witness to this: the premature death of baby Bronagh Livingstone after her mother was refused treatment in Monaghan General Hospital, the delayed cash settlement for liver transplant woman Sylvia O'Leary from his own constituency of Cork South Central, and the continuing Accident and Emergency debacle.

The chief fire officer at the Department of Health's HQ in Hawkins House was called out every time to put out these blazes that were destroying the credibility of the country's health service.

Micheál Martin knows things cannot go on like this which is why he ordered the review of our health services last year. The recommendations of three separate reports on structure, management and manpower have been leaked to the media already.

Next month Mr Martin will officially reveal the proposals. And his firefighting days will be well and truly over, if he succeeds in implementing the most radical reform of the health service in the next four years.

The task of running the country's new National Hospitals Agency and Regional Health Executives will rest firmly with the managers who will get increased executive powers to deliver a more streamlined, efficient service to patients. These health service firefighters will have direct responsibility for the day-to-day running of their own stations and putting out any regional or national fire outbreak.

While overall responsibility rests with Mr Martin, he will not be answering routine call-outs. And his Emergency Response Unit at Hawkins House will only be called when all other avenues have failed.

This will give the minister the space to concentrate on the real business devising strategy and policy.

If he succeeds, Micheál Martin will become the most reforming health minister in the history of the State and put himself back in the running as a possible leader of Fianna Fáil. If he fails, Mr Martin will most likely be exiled to Hawkins House for as long as Fianna Fáil stay in government.

Publicly, Mr Martin insists he wants to stay as health minister to deliver the radical reform promised in his 10-year strategy launched last year.

He now knows exactly what radical reform of the health service's structure the Prospectus Management consultants are recommending.

They say a new national hospital agency should be set up to manage all the country's acute and voluntary hospitals.

They want to scrap the health boards and replace them with a National Health Service Executive with four regional bodies that will be responsible for running the non-acute services.

The consultants are also recommending that politicians be replaced by more professionals and consumers on health boards.

Sitting in his office in Government Buildings, the health minister is reluctant to discuss the detail of what he intends to bring to Cabinet, but he confirms that he broadly backs these proposals.

This is because he wants responsibility for running our acute and non-acute services to rest firmly on the desk of the new executive managers who will head up these agencies.

At the moment, the minister and the Department of Health have executive responsibility for the management of the health services.

"I am like a firefighter and general manager for every hospital around the country when there is a crisis," he said.

However, with the National Hospital Agency and National Health Service Executive having direct responsibility for running the health services, the minister and the department could then concentrate on health policy and strategy.

"This is one of the biggest reforms coming down the road and I am committed to bringing it to Cabinet," he said.

Mr Martin is also backing plans to cut the 58 health agencies that consumers have to deal with now down to 30.

Prospectus Management also recommended that politicians be dropped from health boards and replaced by professionals and consumers.

However, the minister is not happy to do that. "Politicians are not the problem the priority must be the best way to manage services on the ground rather than who sits on boards," he said.

There will be less politicians and less professional representatives on the new executive bodies.

THE second review of health services, the Commission for Health Funding, found that no single person or institution was responsible for the day-to-day management of health service.

Commission chairwoman Professor Niamh Brennan is recommending a National Health Service Executive should manage it and insist on value for money.

And the commission believes consultants and GPs must be more responsible for the money they spend.

The minister is all for making the buck stop firmly on the desks of managers and getting more value for money from a service that demands the biggest share of Exchequer funding amounting to almost 9 billion this year.

Regarding how to make consultants more responsible for the money they spend, the minister says that it will be worked out in the negotiations of their new contracts.

The third review, carried out by the National Task Force on Medical Manpower, is recommending that the health service become more consultant-led and not rely so much on junior doctors.

More contentiously it is also recommending the shutting of six maternity hospitals as well as the downgrading of their accident and emergency services to minor injury units run by specialist nurses.

The task force, chaired by businessman David Hanly, is also recommending that the services provided by all single speciality hospitals be transferred to a network of regional hospitals servicing a population of 350,000 to 500,000 people.

This major restructuring is the trade-off for the appointment of 1,200 extra consultants needed to allow Ireland comply with new EU regulations reducing junior doctors' working hours to 48 a week.

While Mr Martin believes this report will have the greatest impact on the service the patient gets, he will not reveal his own views on the proposals until he gets the official report next month and discusses it with the Cabinet and consultants. The minister is all for the proposal to have consultants on duty 24 hours every day of the week because it will give patients a better service:

"I want to extend the level of cover to 7-24 so that if a person goes into hospital at 2 o'clock in the morning a senior consultant will be on hand to make a decision about what will happen to them."

The Irish Hospital Consultants Association (IHCA) has been demanding 1,000 new posts for some time. It remains to be seen if Mr Martin will deliver the 1,200 extra recommended by the manpower task force.

This is fraught with difficulties because the devil will be in the detail of the new contract due to be negotiated with the IHCA.

The department will want more accountability and less sociable working hours in return for these extra posts. It remains to be seen if the country's consultants will continue to enjoy their untouchable status.

The trade-off of shutting six maternity and A&E departments around the country will also be a political banana skin particularly with local elections coming up next year.

The success or failure of Micheál Martin's reforming package depends on three things his own determination to bite the bullet and push through unpopular decisions, Finance Minister Charlie McCreevy's willingness to loosen the purse strings, and Taoiseach Bertie Ahern's personal backing.

The jury is out on Micheál Martin's determination to bite the bullet. So far, his reforming spirit has only been seen in his crusade to ban smoking in public places.

Charlie McCreevy is likely to agree any reform that will not cost him money any project that does will have to be justified by major long-term savings.

The Taoiseach's support will depend on whether he believes any of these reforms will hurt Fianna Fail's chances at the local elections next year or down the road when he goes back to the hustings.

It will also depend on whether or not he wants Micheál Martin to improve his leadership chances by succeeding as a reforming health minister.

Only Bertie knows the answer to that one.

Nevertheless, it will determine if Micheál Martin will spend the rest of his political career as a Hawkins House firefighter or gets the chance to lead the Soldiers of Destiny.

CV

Name: Health Minister, Micheál Martin

Age: 42

Constituency: Cork South Central

Education: Coláiste Chriost Rí Cork, University College Cork BA, H dip Ed, MA.

Family: Married to Mary O'Shea, two sons and two daughters.