Treatment Purchase Scheme has quietly begun to do the business

Not only did it stink, every aspect of it stank. Especially the timing. Just as the Minister for Health was about to unveil his national Health Strategy, out of left field came the Treatment Purchase Fund.

"Out of left field" is figurative, rather than political, since the idea actually came from the Progressive Democrats, whose field tends to be on the right, rather than the left. Fianna Fáil believed it should have been shoved right back into whichever field it came from. And concealed under the nearest cow-pat. It exemplified an aspect of the PDs the Soldiers of Destiny will never get used to: the ruthless separateness of the smaller party.

Fianna Fáil thinks if you go to bed with a political partner, once the earth stops moving, they should act like you and think like you. Whenever Fianna Fáil goes to bed with another party, it grows to genuinely like, trust, and feel comity with them and convinces itself that it's just an oddity of circumstance that keeps the smaller group from realising they really and truly belong in the Fianna Fáil bed permanently. Until the smaller party comes to that realisation, Fianna Fáil expects them to at least show solidarity.

The PD attitude to going to bed with Fianna Fáil is that the smaller party is going to respect itself in the morning. Every morning. Bertie and Michael Mc D may genuinely like each other and work productively together, but let the Bertie Bowl raise its expensive head and, overnight, it's separate bedrooms.

This is complicated by contrasting attitudes to what happens when the alarm goes off in the morning. Fianna Fáil are easy-going on this. Their attitude is that whoever's up first makes the breakfast. The Progressive Democrat attitude is that whoever's up first makes the headlines. And it's going to be them.

So, last year, just when Fianna Fáil thought the Minister for Health had earned himself a bit of a sleep-in while his strategy got printed, the Progressive Democrats came up with this bolt-on device called the Treatment Purchase Fund. Like a side-car for a canoe: another inelegant and contradictory add-on to a national health service which already has so many add-ons, it's riding low in the water with waves constantly coming over the gunwales. (Assuming canoes have gunwales.)

When the PDs pull something like this out of Fiona O'Malley's hat (which has to have some function apart from generating shock and awe on the first day of a Dáil session) the Minister for Health smiles and promises to consider it. The Minister for Finance sees merit in it, as he does in almost anything that isn't a tribunal or a public enquiry. The Taoiseach indicates he'll live with whatever his Minister decides, which is shorthand for "and he won't be dumb enough to decide something that'll put us out on the street". In no time at all the canoe has a side car.

When the Health Service had the Treatment Purchase Fund hammered on to its flank, those within Fianna Fáil harbouring a visceral need to tell the PDs what to do with their latest bit of attention-getting opportunism were torn. On the one hand, they hoped the thing would be unworkable and go belly-up. On the other hand, they feared that if it died, blame would be attracted to the bigger party, as tends to be the case.

The basic function of the side car was to arrange treatment for the 'long-waiters' who have been hanging on for their replacement hip since before the invention of the mobile phone or so it feels. Media loves stories of thousands on the waiting lists, but to the person with the gammy hip, the issue is not the numbers on the list, but the length of time they've been on it with no side of getting treatment. The objective of the Fund was to ensure that adults wouldn't have to wait for more than twelve months, and children's wait should be no more than six months.

It got off to a slow start and quiet murmurings of "See? Told you it wasn't that simple," were heard. They died out, though. Now, five and a half thousand people have been treated and the balance of the planned 8,300 will treated between now and the end of the year. Many of those 8,300 have been waiting anything from two to eight years. The longest waiters will have been treated and removed from the waiting lists by December.

The Fund relies on the private providers of healthcare, partly because they have more capacity, and partly because the private system doesn't have A&E and not much critical care either. Both are the areas that given winter vomiting bugs or any other seasonal problem push the entire system within a hospital out of shape.

By definition most of the conditions treated are life-disruptive rather than life-threatening. All of the interventions are surgical, rather than therapeutic. Which means they can be discretely costed. Unit-costed. One hip replacement takes X number of components, Y hours in theatre. Z days recovery. Therefore the cost for an average hip replacement will be predictable. Cancer treatment, on the other hand, is the classic piece of string: at the outset, nobody has any idea how long, complicated or costly it's going to be.

Most of the operations have been done in private hospitals here, in the North and in Britain. Patients love the way the thing works. The lo-call line has had almost 5,000 serious calls from patients or their representatives, seeking surgery through the Fund.

Not everybody has been so enthusiastic. One hears of particular hospitals where the corporate culture goes into spasm at the very notion of releasing patients to the UK. The phrase 'releasing patients' has an odd but accurate resonance of the proprietary nature of the relationship between some consultants and their patients. The surgeon may not be in a position to remove that gallbladder anytime soon, but if the patient wants it done in the UK, the patient has to formally request it and some are reluctant to do so, lest umbrage be taken. Waiting lists give doctors a lot of control. In Ireland. In most other countries in Europe, the hospital controls the waiting list, not the consultant.

Despite opposition both overt and covert, the Scheme, run by a quietly relentless American management consultant, is doing the business. The quiet relentlessness is undoubtedly part of its success. Its boss isn't into big statements. She just keeps her eye on the ball and seems to be able to spot when a public hospital just might be trying to solve its funding problems by playing footsie with its own numbers.

So, all hail the PDs for pulling it out of Fiona's hat. And all hail the Minister for Health for adopting it as if it was his own.

However, it will be interesting to see if the Government as a whole cops on to the lesson the Treatment Purchase Fund delivers: that imaginative, workable, short-term, bolt-on mechanisms for solving the immediate problems unmet by overall Government policy are the elements of innovation and lateral thinking which make long-stay Governments tolerable.