Heart Beat: One of the many rewarding aspects of having more time is that you can read more extensively. Naturally, given my background, matters medical interest me greatly.
There would appear on the one hand to be few problems, with major action under way at all levels to straighten out any difficulties we may have and to set a course for orderly development into the future.
Very fair, and no reasonable person could cavil with the objectives.
The Minister for Health, Michael Martin, has appointed the chairman of a national steering committee to oversee the health reform programme. This group would oversee the different strands of the programme which, according to the Minister, is "unprecedented in its scale, breadth and complexity". There are nine members of this committee and not one comes from the medical or nursing professions, let alone from the front line.
We also have now an interim board of the Health Services Executive, which, we are told by the Minister, will be the first body charged with managing the Irish health service as a single national entity.
We are told that the principles underlying the reforms are:
a new national focus on service delivery and executive management of the system;
a major reduction of fragmentation within the system;
clear accountability throughout the system;
improved budgetary and service planning, and most importantly;
improved patient care.
I am afraid that I am petty enough to think that the last point should come first and that everything else follows. This interim board has 11 members, this time there is a medical and a nursing presence, one of each, both professors.
What is not clear to me, and I suspect to many more people, is exactly what they are going to oversee? What exactly are they going to implement? The Prospectus Report, the Brennan Report, the Hanly Report, the National Health Strategy - all of these, or parts of these or what?
Might one ask then what is going to happen to the Department of Health and Children? I know that I will be told that it will direct and formulate policy. Perhaps that helps to explain the situation we are in at the present.
The capacity for self-delusion and the attempted delusion of others has no place in the provision of a caring health service. I might begin to believe if the patients no longer had to wait on trolleys and in chairs in overrun accident and emergency departments. I might begin to believe if routine admissions for investigation and surgery were not repeatedly deferred to take the emergencies from casualty departments. I might begin to believe if the facilities existed to move long stay patients out of the acute hospitals.
Have I any other reasons for my disbelief?
Dozens, starting with the very simple one - what took so long? This problem is not of today or yesterday but has been built on years of under-provision and laissez faire attitudes. Now we are expected to accept that more committees, reports and words will solve the problems. I wish it were that simple.
To return to a point made above, what is Government policy for the health service? Do the detailed objectives outlined for instance cover the private section? If they do, why is there discord over the Enterprise Liability Scheme? This is particularly intriguing given that the National Treatment Purchase Fund refers many to the private hospitals. Are public patients treated in private hospitals to be covered by the new scheme? If so, what about private patients who additionally pay for insurance over and beyond their entitlement?
Have all these aspirations been costed? How much is it all going to take and where will the money come from? Have all the medical, nursing and paramedical groups signed up and if so, to what?
Have the infrastructural problems, training of ambulance personnel, improved roads to facilitate the easy and safe passage to the centres of excellence been achieved? Will there be a helicopter service for the gravely ill to come in from the periphery?
We are told that there are to be 13 action projects, by health board chief executives (possibly an endangered species) and a member of the department, to deal with a range of issues required to establish the new structures. Are these 13 additional to the 58 agencies already operating in the public health service system?
We are told that clarity about roles, accountability and "where the buck stops" must be completely clear.
At least amid all the verbiage the last point is completely clear. It stops with you Minister for Health.
• Maurice Neligan recently retired as a leading cardiac surgeon.