Long-term funding vital to success

THE Achilles heel of Health Minister Micheál Martin’s plan to reform the health system is the lack of any commitment to fund this ambitious programme to streamline a crisis-ridden and creaking service.

But there is no denying the minister deserves to be applauded for having the political courage to confront the enormous but necessary task of revamping a system characterised by never-ending hospital waiting lists, cutbacks, bed closures and vested interest power groups.

Reforming the service will involve abolishing the country’s health boards, reducing the powers of elected representatives, and setting up a centralised executive to replace the department and oversee the operation of four regional agencies plus 32 area offices.

No health minister in recent times has been willing to take on the daunting challenge of removing decision-making powers from the arena of local politics, an initiative certain to prove unpopular and which could yet trigger a grass roots revolt.

The display of urgency towards renegotiating consultant contracts is commendable.

The coalition can be assured of public support if it succeeds in breaking the grip of powerful consultants on a two-tier system, where public patients have to queue for years before receiving treatment while people who can afford to pay get a fast-track service.

It is time to end this unacceptable form of cheque- book medicine by dismantling the mini-empires which consultants have built up within the hospital network.

The minister must renegotiate their contracts, insist on exacting a better deal for ordinary people, and delimit the use of public hospital facilities for the private patients of wealthy consultants.

To his credit, Mr Martin is already busy selling the reform package, briefing health board managers, consultants and the trade unions on the plan to revamp the service.

Significantly, the nurses’ union has broadly welcomed this initiative to speed up reform and streamline the decision-making process.

Tomorrow, he will confront elected representatives who see the creation of a centralised executive agency as an attack on local democracy.

While the issue of accountability has yet to be clarified, the minister must face up to local representatives, especially those in Fianna Fáil, who have politicised health matters for years.

Effectively, the plan is based on two documents, the Brennan and Prospectus reports. A third study, the Hanley report, is imminent, and will highlight the urgency of overhauling the country’s hospitals, including possible closure of some, another politically explosive issue.

What is now patently clear is that taxpayers are not getting value for money from the service and there is a glaring lack of control over spending.

In this respect, the reform package is a vindication of Finance Minister Charlie McCreevy’s refusal to continue pouring money into the black hole of the health system.

From here on, decision-makers must be made responsible for resources, and consultants must be answerable to taxpayers who pay their huge salaries.

But unless the Government reverses its swingeing cutbacks and abandons its fire-brigade approach to funding, the promised reforms will be seen as a smokescreen to cover broken electoral promises.

It is crucial for Taoiseach Bertie Ahern and Mr McCreevy to support the Martin plan.

Otherwise, this first step towards creating a world-class health service for patients could come to naught.

No matter how worthy it may be, without long-term funding or the political will to take on powerful vested interest groups, this brave new policy will be in doubt.