Interests of patients must come first

POLITICALLY, it was refreshing to see Taoiseach Bertie Ahern get off the fence and confront Fianna Fáil deputies who oppose the Hanly Report on reform of the health service.

Socially, it would be hard to exaggerate the significance of this crucial document. Not alone does it set the scene for reorganising the country’s hospitals, it will be a key factor in tackling the disparities of a cheque-book health system dominated by consultants and where public patients are treated as second class citizens.

Doubtless, Mr Ahern was stung by criticism of his weak response to the mini-rebellion by Defence Minister Michael Smith who spoke out against the implications of Hanly for Nenagh Hospital.

Apparently, the Taoiseach was less concerned over the minister’s blatant breach of collective Cabinet responsibility than by perceptions his authority had been challenged.

Having put an end to the minister’s solo run, albeit reluctantly, Mr Ahern is now moving to dam the growing tide of resentment from politicians who fear Hanly will torpedo their prospects in next summer’s local elections.

Controversially, the report would transform major hospitals into centres of excellence and remove services from local hospitals, beginning with trial runs in the Mid-West and the East.

In a rare show of strength from a Taoiseach whose leadership has been deeply ineffectual, Mr Ahern yesterday put down a marker, telling opponents of Hanly that instead of marching, they should read the report and spread its message.

He is acutely aware of the mounting opposition, as evidenced by the turnout of 20,000 people in Ennis against any proposal to strip services from its general hospital.

Nothing is more calculated to concentrate the mind of a Fianna Fáil leader than the spectacle of Soldiers of Destiny marching beneath a party banner in opposition to his government’s policies.

But Mr Ahern is nothing if not shrewd. Thus, despite throwing his weight behind Hanly, he emphasises the report will take a decade to implement. In a further conciliation gesture, he assured its opponents that all views would be taken into account in the implementation of the proposed reforms.

Aware of the difficulties confronting Hanly, Health Minister Micheál Martin has also come out with guns blazing, challenging its opponents to come up with an alternative.

Besides claiming that many hospital consultants support the plan, he emphasises that the Government has no alternative in the light of the legal requirement to reduce the working hours of junior doctors to 48 by 2009.

Under the present regime, many doctors work to the point of exhaustion, clocking up over 75 hours a week, a totally unacceptable and hazardous scenario in which lives are put at risk.

It would be foolhardy of either the Taoiseach or Mr Martin to imagine the Hanly rebellion within Fianna Fáil has been snuffed out. With a nationwide campaign against its implications gathering momentum, the report could be blown out of the water by popular opposition to closing down local services.

If that happens, then desperately needed reforms of the health service could be set back for years. It is essential to create a health service where the patient’s interests are paramount.