Martin's mission: to get Health back on its feet

The boyish enthusiasm is still intact. MichΘal Martin may have just been told that the Deloitte and Touche Value for Money Report, which criticised the health boards in particular, was inadvertently placed on the Department of Health website, but he retains his personable demeanour, despite the inevitable annoyance he must be feeling at this unplanned interruption to the launch of his health strategy.

So why did the strategy avoid health board reform, when both the Department of Health and Children and those working in the front line of healthcare face significant changes in the way they work? The Minister maintains that health-board changes are referred to in the document.

"It may appear vague, but it is dealt with in the Health Strategy. What we're about is transforming people", he says in reference to the human resources analysis contained in the strategy document. "We stood back from the abolition or amalgamation of health boards and concentrated on the human-resource issue instead."

But isn't it time that the local administrators of our health services were paid and promoted based on performance and the meeting of targets? He does not rule this out and says performance-related pay is coming.

"But we have an issue here for health board CEOs. The Buckley pay review was not kind to them", he says, pointing out that the last chief executive of Beaumont was recently head-hunted by the private sector Bons Secours Group of hospitals, who were able to offer a significantly better remuneration package than the public service could.

The Minister says he is aware of problems within the health boards and that these were pointed out to him during the strategies consultative forum meetings by those working in the private sector. But he does not share the view that the health boards are top-heavy with administration. "There are about 12,300 administrators in the system now, representing 14-15 per cent of the total number working in the public sector. Two-thirds of these, I'm told, are frontline staff who work backing up consultants."

His failure to widen medical-card eligibility until 2003 has been severely criticised. What is his response? "I have thought this through carefully. The priority has to be on infrastructure. If you flood it \primary care you are giving access to what is generally agreed from the consultative process to be an inadequate infrastructure, with 50 per cent of GPs not having a secretary or a practice nurse. I think it is important that when we don't have endless resources in any one year, we need to beef up the practice infrastructure first."

The Minister did confirm that the revised medical-card income guidelines will be weighted towards families with children. Acknowledging that his Chief Medical Officer had identified equitable access to healthcare for children as a priority in a recent annual report, Mr Martin says: "\ will be the major skew when it comes to offering medical cards to an additional 200,000 people. There will also be a clarification of the guidelines under which health board CEOs issue discretionary medical cards. There are clearly variations between health boards in terms of how they administer these."

How does he respond to criticism of the Health Strategy's failure to explicitly commit itself to an equitable system for accessing hospital care, such as a single waiting list? "De facto, we won't have a waiting list", he says in reference to the combined effects of the hospital treatment fund and increased beds and staffing, "but there is also the element of clinical autonomy in that at the end of the day what is a national waiting list?"

Mr Martin feels that it is ultimately the consultants who will decide who goes on a waiting list and that it is up to them who is operated on or receives treatment first. "But what we are working towards is a database in terms of waiting times in specialities. I think in time, as we move on with the quality framework coming into place, and with additional beds that we will get a clearer picture of who is doing what and who isn't doing particularly well".

How would he like to see hospital consultants working in the future? "The system does need more consultants. I think we also need agreement on flexibility and rostering if we are to genuinely have a consultant-provided service."

The Minister would like to see newly appointed consultants work differently and he confirmed that they would be expected to provide three years of full-time public work before moving on to private practice. He does not expect the medical organisations to block this proposal, although he does acknowledge that there will have to be negotiations to tease out the details.

He agrees that there is a perception that some consultants disappear off to their private practices following a minimum input to their public patients. Is there not an argument for confining the new appointees to a single site to improve integration? "There are efficiencies there, for reasons other than being on the one site. Ideally yes, but we cannot abolish the systems which are there but we can work towards this and I think in specialities like cancer this is what is already happening."

Will Fianna Fβil campaign in the next election on the basis of delivering elements of the strategy should it form the next government? "We will as a party be saying, even though the strategy is not ours, yes, it will be a central part of our proposals". And while he would not see Fianna Fβil as the guardians of the strategy "we do have a commitment to it because obviously we formulated it, and we will be saying to the people you can trust us to implement it."

What of people's fears that if the country goes into a prolonged recession the resources won't be there to implement the plan?

"I think that people want a better health system and that they will not forgive any government, irrespective of its colour, that does not deliver on the strategy," the Minister says.

It is his personal opinion that a more transparent system of funding the health service must be found.

"There is going to be some form of revenue generation required for the cost of health into the future, and certainly the kind of transparency you are talking about could be a good idea and also would challenge people out there to say 'We can't get this for nothing' and there is a price to be paid. And on the other side of the argument people will want to see that they are getting value for money."

Was the Minister surprised by the reaction of the VHI to his plans and in particular to its claim that non-emergency hospital treatment of private patients would have to be suspended?

"I was very surprised by it, by the nature of it, and I thought it was over the top."

Referring to the 80-20 split between public and private activity in hospitals, he says there has been slippage to a 70-30 breakdown. "Hospital authorities shouldn't allow that slippage to occur.

"We reserve the right, and it is a reserved function, to go into hospitals and senior consultants and say, 'Look, this has gone seriously askew in your hospital. Put it right'. But it is not the wholesale postponement of private admissions which was suggested."

He is happy with the overall reaction to the strategy although he wonders whether people realise the significance of the bed-capacity initiatives and the specific proposals made in relation to the elderly.

MichΘal Martin may have inherited the "poisoned chalice" of health but he looks set to hand over a Department which will no longer be seen as a potentially career-stopping black hole.

Whether his strategy succeeds in winning the Government another term in office remains to be seen.