Reilly's first year: we're still waiting
When the Minister for Health took office a year ago, promises were made to reform the health service in an era of shrinking resources. How’s he doing so far, asks PAUL CULLEN
ARGUABLY JAMES Reilly’s main achievement in his first year as a minister has been to keep health off the front pages.
Dr Reilly has set himself an ambitious and challenging programme to reform the health services over the five-year lifetime of the Government and must try to achieve his objectives in an era of shrinking resources.
However, it is health’s unerring capacity to lay banana skins for successive ministers to slip on that has caused Dr Reilly’s predecessors so many problems.
So far, he has managed to avoid many such pratfalls, while the national focus on the economic crisis has left him space away from the limelight to plan the reforms he has championed.
As a medical doctor himself, Dr Reilly will be familiar with the advice to his profession to “do no harm”. In this case, the patient, in the form of the health service, is, on balance, no worse than he found it when he took up office last March.
But to what extent has he improved the service, and what progress has he made in implementing the promised reforms, which are set out on seven pages in the Programme for Government?
TROLLEY WAITS AND OTHER DELAYS
According to the Irish Nurses and Midwives’ Organisation, 2011 was the worst year for patients on trolleys since the organisation began keeping records in 2004. Over 86,000 patients spent time on a trolley, up 14 per cent over the previous year.
However, the headline figure conceals other trends, some of them positive. Trolley waits fell in Dublin, but grew significantly outside the capital. The situation improved as the year went on, so that by December the INMO figures were 13 per cent down year-on-year. (The Minister claimed a 40 per cent reduction in the last four months of the year.)
The milder winter helped, of course, but even the INMO has acknowledged the difference being made by the Special Delivery Unit set up by the Minister to tackle the crisis of overcrowding in the health service.
Dr Reilly appointed Dr Martin Connor, who is credited with cutting waiting times in Northern Ireland’s health system, to head up the unit last year.
By last January, the Minister was expressing cautious optimism that the reductions in trolleys could be lasting. Now the target – a modest one – is that no one should spend more than nine hours in an emergency department before being seen.
In the same month, though, figures showed the number of people waiting for more than three months for day procedures in public hospitals grew by 7,000.
Verdict: The improvements are welcome, but it’s too early to say if they will last.
HEALTH SERVICE REFORM
The Government is committed to the introduction of a single-tier health service underpinned by universal health insurance, but not until early in the lifetime of the next administration in 2016 or 2017. Before this can be done, waiting lists have to be cut and a promise to introduce free primary care implemented.
Some early steps have been taken, such as the appointment last month of an expert group to develop plans for the implementation of universal health insurance, and preliminary moves leading to the abolition of the HSE. The first phase of free GP care is to be provided to 56,000 patients covered by the long-term illness scheme shortly.
However, not much has been heard of the promised patient safety authority, and some experts are doubtful whether the overall plan can be implemented with the timeframe promised.
Verdict:Too early to tell whether these plans will become a reality.
The health system has not escaped lightly from current cutbacks in Government spending. The total drop in funding this year is of the order of €850 million.
Over half this is due to a net cash reduction from the Exchequer, as well as additional costs for pensions, medical cards and the Fair Deal nursing home scheme. The rest is the result of the payment of increments to staff and the Budget increase in VAT.
Not surprisingly, these cutbacks are putting real strain on services. Up to 1,000 beds in community nursing homes may be closed, and patients with private health insurance will face higher charges because the cost of private beds in public hospitals is being increased.
It is also expected the planned operations will have to be postponed as the cutbacks bite.
However, the cutbacks which have attracted the most attention are those which affect particular services, especially in rural areas.
For example, the closure of the emergency department in Roscommon hospital was the cause of massive controversy in the county, particularly because both Dr Reilly and the Taoiseach, Enda Kenny, had promised before the election that services in the hospital would not be affected.
Verdict:Dr Reilly will remain vulnerable to localised campaigns over health cutbacks, and will have to hope that a system held together with sticking-plaster does not meet a major emergency.
THE HEALTH AGENDA
The good news is that Irish people are becoming healthier, but the picture is not uniformly good. Life expectancy is improving, as are many cancer survival rates.
However, the prevalence of smoking remains stubbornly high, binge drinking is a problem and obesity rates are spiralling.
Dr Reilly preaches the message of health promotion, but the acid test will lie in whether he has the courage to introduce effective measures in the face of determined opposition.
He has talked about introducing a floor price for cheap alcohol as well as other measures to restrict the promotion and advertisement of drink, but fellow Ministers at Cabinet have voiced their opposition to measures which would hit employment or tourism.
He has also mooted some form of “sugar tax” on sweet drinks but has yet to get this proposal through Cabinet.
Verdict:The proof of this pudding will be in the eating.
NATIONAL CHILDREN’S HOSPITAL
An Bord Pleanála’s decision to refuse planning permission for the proposed national children’s hospital on the Mater site has effectively torpedoed the Government’s plans to build a flagship project during its lifetime.
Sources say the Minister was enraged at the decision, and may yet try to get it back on track. While it’s a mess he has inherited from the previous government, Dr Reilly did take time to reflect on whether the Mater was the right site immediately after he took office. He eventually pinned his colours to the mast after an advisory committee recommended it as the best option in the circumstances. The fact that the Government seemed to have solved the funding issue – the proposed sell-off of the National Lottery would provide most of what was needed – made the board’s decision even more frustrating.
Verdict:The Minister will have to produce miracles in order to get the project completed in the lifetime of the Government, as the Taoiseach has promised.