Local voices and vested interests divert attention from health issues

The first rule is that in Ireland all health politics is personal. Everyone comes to the health debate with a personal emotional framework.

We all interact with the health service when we are at our most vulnerable.

If we have had reason to go to hospital with all the breach of personal dignity this can involve then that experience is likely to shape our view of the health services.

Those of us who are fortunate enough never to have been seriously ill are likely to have experienced the health services close up when illness touched a close family member or a friend or perhaps during the last days or weeks at the bedside of a dying parent.

More than anything else, these experiences will shape the personal emotional framework which we each will bring to all debates about health policy.

Health Minister Micheál Martin made this point of sorts on the Late Late Show the other week.

He talked about how there is no point in telling someone who has had a bad experience in a hospital that the health services isn't in "crisis".

The minister had an almost impossible task that night trying to argue that the health services are improving on a macro level with a panel of people who themselves have had a recent bad experience in accident and emergency.

It was interesting however that when the discussion went wider than the already miked-up sections of the audience, three people in a row went out of their way to make the point that they themselves or someone close to them had recently had a positive experience with the health services.

The second rule of health policy debate is that all health politics in Ireland is local.

The minister will have some difficulties with local politicians who will lose positions when the health boards are rationalised.

However, I suspect that in the struggle to reform the health service these local politicians will be the least of Micheál Martin's problems.

The greater local political pressures will be about where and how hospital-based services can and should be located and delivered.

The Prospectus Report, which is one of the three reports we will spend the coming weeks discussing, is said to recommend a greater concentration and specialisation of services such as maternity and oncology.

It is difficult to tell voters in a given county that their children must be born in another county.

It is difficult to tell cancer patients and their family members who want to visit and support them during their treatment that they must travel to Dublin or one of the other large cities to get treatment.

All the medical expertise may argue that delivering cancer treatment in more centralised and more specialised hospitals will increase recovery rates but persuading local communities of this is more difficult.

This point was illustrated starkly by the results of last year's general election.

Concerns about the level of services at Ennis hospital played a part in the election of the independent James Breen in Clare.

Ballinasloe hospital was a factor in the surprise success of former Fianna Fáiler Paddy McHugh as an independent in Galway East.

The campaign for the retention of maternity facilities at Monaghan hospital was a major factor in Paudge Connolly's victory in Monaghan.

Even the surprising election of Rosslare GP Liam Touhey Twomey to Dáil Éireann for the Wexford constituency was contributed to by local concerns about the downgrading of Wexford hospital.

The salutary lesson of the elections wasn't that the health service must stay localised but that the minister still has a lot of work to do to persuade voters that local is not necessarily best and that localised sensitivities will have to be sacrificed in the interest of improved care and improved rates of cure.

The third rule of health policy debate is that many of the voices talking about health policy have a vested interest.

Because health is a specialised area many of the writers on health issues in the media are doctors or other health professionals.

In addition many of the most oft-quoted health experts also have a vested interest working for medical journals or internet websites which are vehicles for advertising to medics.

The extent to which this can at times distort balanced coverage of the health policy debate has been apparent in the coverage of the public health doctors strike.

The only journalist I recall who took issue with the public health doctors for going on strike in circumstances where they were already in line for substantial pay increases was the industrial relations correspondent of one of the national papers.

I cannot recall one of the medical or health correspondents who had a view on this strike different from that of the Irish Medical Organisation.

Instead there have been several stories, especially Sunday newspaper stories, with bald headlines claiming that escalations of the strike were imminent.

These stories claimed first that GPs were going to go on strike in sympathy with the public health doctors and then that hospitals were going to be closed by pickets.

Despite these reports, neither of these escalations has occurred.

In endeavouring to communicate his policy the minister will have to contend with other vested interests in the health service itself who are all adept at utilising the media.

The unions and professional organisations representing those who work in the health services have a right to represent their members and also have a right to be heard in the wider public debate about health policy.

However, they don't leave their vested interests outside the door when they walk into a television studio to participate in a panel discussion about general health policy.

When Liam Doran of the Irish Nurses Organisation talks about the health service the interest of the patients are of course among his concerns but his primary concern is the interest of nurses.

When the interests of patients and nurses coincide, patients will benefit from Liam Doran's contribution.

But where the patients' interests differ from those of nurses then Liam Doran does his job and speaks in the nurses interests.

Similarly, when Finbar Fitzpatrick, as the spokesman for the Irish Hospital Consultants' Association gives an opinion about the health service, his first interest is that of the consultants whom he is paid to represent.

The fourth rule of health policy debate is that everyone wants better health services but most are not prepared to pay for them.

In fairness to Mícheál Martin, he has not been behind the door about making the point that the health services will not improve without increased expenditure.

What will make the coming weeks of debate particularly difficult is that there has been a lazy acceptance in many media and political quarters of the McCreevyite assertion that the persisting problems with the health services are solely or mainly because of maladministration or lack of financial accountability.

There is a structural deficit in our health services because of historical cuts and under-investment.

Our health services require capital expenditure to build hospital and facilities and to improve bed capacity.

They also require increased numbers of staff on an ongoing basis.

Our ageing population makes this need all the more pressing while medical inflation will make it all the more expensive.