Following another difficult year for the health service in 2007, marked by a significant loss of public confidence in cancer care in the State, will 2008 be better?
Optimism and the health system are not natural bedfellows but the appointment of Prof Tom Keane as director of the National Cancer Control Programme offers new hope. Having overseen the overhaul of cancer services in British Columbia, a Canadian province with a similar population to the Republic, he has extensive experience of the rationalisation needed to implement the 2006 cancer control strategy. But he must be given sufficient funds to complete the process and be afforded every co-operation to facilitate rapid change. The memory of Susie Long and the ongoing saga of breast cancer misdiagnosis demand nothing less.
The future of the Health Service Executive (HSE) must be addressed early in 2008. Widely seen as faceless and dysfunctional, its monolithic structure needs to be reconsidered. Nor is it a transparent organisation, a key failing when public confidence is such a vital element of healthcare. There is no quick-fix solution; however, leaving it to wallow in a mire of inefficiency is not an option.
Improvements for patients are closely linked to staffing levels at the clinical coalface. Now that it has entered a new financial year, it is to be welcomed that the HSE has dropped the staff recruitment embargo it imposed in the autumn. It is not rational for the State to invest heavily in expanding training of badly needed paramedical and other health professionals only for new graduates to emigrate because of a recruitment ban by the HSE.
HSE chief executive Brendan Drumm has said that the expansion of primary care is a key element in his strategy for health service reform. But few of the 100 primary care teams promised in 2007 are up and running, casting a shadow over plans to develop a further tranche of expanded community care facilities in 2008.
Last year saw the passing of a new Medical Practitioners Act. But fears about its knock-on effect on the recruitment and training of doctors mean it could be mid-2008 before patient safety will be enhanced.
There is good news on the public health front. A budget decision to fund the inclusion of hepatitis B and pneumococcal vaccines in the childhood immunisation scheme will benefit children. The pneumococcus jab will especially help reduce meningitis rates, adding to the success of the meningitis C vaccine programme.
But significant public health challenges remain. Rising obesity levels, an increase in the incidence of liver failure and other alcohol-induced problems in young people and the continuing fallout from our growing drug culture require renewed focus. Unlike her predecessor, Minister for Health Mary Harney has not exhibited a particular interest in disease prevention. With up to four years remaining in office, she has the time to adopt a single public health intervention, similar to the smoking ban,that would positively influence the health of the nation.