Reform delays could prove costly

WHEN the Brennan Commission report on value for money in the health service came out it was acclaimed as a long overdue assault on a two-tier system where the rich get instant treatment and the poor join endless hospital queues.

But since its publication last March, the radical document has suffered the fate of many a report, gathering a fine layer of dust on a department shelf.

Because of this tardiness, Professor Niamh Brennan, chairperson of the group behind the study, has taken the unusual step of breaking her silence and criticising the delay in appointing key personnel needed to drive reforms of the creaking system.

It is worth citing Prof Brennan’s uncompromising statement carried in the current edition of the Irish Medical Times.

“We finished our deliberations on January 31 and presented our report to the Minister on March 31. That there would be little progress on implementing the recommendations in the way we set out by the middle of September gives me cause for concern.... I would like to see somebody with a can-do attitude heading up this change process and not somebody saying it will take 10 years.”

As he visits New York to observe the impact of the smoking ban on bars there, Health Minister Mícheál Martin should dwell on the fall-out of further delays in overhauling the health service here, depoliticising its decision-making process, reducing the number of health boards, and creating more effective management.

He also has questions to answer. Why, for instance, has a chairperson not yet been appointed for the proposed executive to run the health service on a day-to-day basis?

Why has nobody been appointed to head up the vital steering group that would oversee implementation of the 136 recommendations outlined in the Brennan report?

Judging by the Department’s seeming lack of urgency in filling these posts up to now, what faith can be placed in its assurance that the executive will be set up in the autumn and the implementation committee created within weeks? At the earliest, it will be November before a chief executive can be recruited.

Again, why has the Hanly report, the third element of the reform process, along with the Prospectus and Brennan reports, not been published though it was finalised early in the summer?

Given Mr Martin’s determination to drag the health service into the 21st century, it has to be asked if the brakes have been put on these reforms by Finance Minister Charlie McCreevy? Ironically, as the Minister controlling the public purse, he has been vociferous in demanding better value for money in healthcare.

Not only will further delays prove costly, they would also be counter-productive because the new executive would remove the “firefighting” burden from the Department, enabling it to carry out meaningful planning on a long-term basis.

In addition to its organisational and management goals, a key priority of the shake-up envisaged by Prof Brennan will be greater accountability, transparency and probity in the system.

Above all, there is an urgent need to strip vested interest groups of their excessive powers. It is absolutely essential to establish a healthcare service where the needs of public patients are not sacrificed on the altar of financial greed.