Health service needs ministerial transplant from North

IF, AS I am wont to do, I call for Mary Harney to take responsibility for the shameful mess of the health services and resign, I usually get looks of withering contempt from political realists.

Do I, they ask, seriously think that anyone else would take the job? The rhetorical question sums up the decrepitude of our political culture. In the three parties that make up the Government, there is not a single credible figure willing to take on the job of saving the lives of thousands of their fellow citizens every year.

Given this moral cowardice, I have a modest proposal. In the spirit of cross-Border co-operation, let's ask our friends in the North if we can borrow Michael McGimpsey for a couple of years. Last week, the health stories in the South were about the 500 people a year who die unnecessarily from strokes, Crumlin hospital taking the wrong kidney out of a child, the death of Tania McCabe in Our Lady of Lourdes Hospital because of staff shortages, and Peg McEntee's appalling ordeal in the Mater hospital's A&E.

It was hardly surprising that little attention was paid to the release of figures by the health department in Northern Ireland. This must have come as a great relief to Mary Harney, because the figures give the lie to the notion that health service problems are intractable. They suggest that with decent leadership, death and misery can be greatly reduced.

Two years ago, there were 111,000 people in Northern Ireland waiting more than 13 weeks for a first outpatient appointment. As of the end of March, there were just 55. In the same period the number of patients waiting more than 21 weeks for surgery has fallen from 10,000 to 56. Last June there were 7,649 patients waiting longer than 13 weeks for a diagnostic test. Now there are none at all. Waiting times for physiotherapy and occupational therapy have been virtually eliminated. Most significantly, ambitious targets for waiting times in A&E look like being met. This time last year, 81 per cent of patients were being seen within four hours. Now, the figure is 92 per cent.

To put this into context, Mary Harney's target for A&E waiting times in the Republic is 12 hours. Last month, waiting times at Mayo General Hospital reached 24 hours and waiting times of up to 48 hours have been experienced by patients - including a 93-year old woman with a suspected broken hip - in the Mater recently. While the experience of waiting for long periods on trolleys has been virtually eliminated in the North, there were 320 people on trolleys in A&E units around the country at the start of last week.

Under Mary Harney, the Republic can't meet a target three times worse than the one Northern Ireland is achieving. And it can't even meet its targets for setting targets. In December 2006, Mary Harney's taskforce on the A&E crisis set a deadline of February 1st, 2007, for a detailed plan to reduce the target waiting time to six hours - a goal it declared "realistic". The first anniversary of that deadline has come and gone to the sound of silence. So has the second anniversary of Mary Harney's declaration that the state of our A&Es is "a national emergency".

Why can Michael McGimpsey deliver stark improvements of front-line services for citizens north of the Border in less than two years while Mary Harney fails to do so in 3½ years? The answer is not simply about money - the A&E improvements in the North have been achieved without significant new funding. It is about two related things - good leadership and a commitment to a single public health system that aims to treat people equally. Without the distractions of constructing a vast bureaucracy and generating a market for private, for-profit care, the system in the North can focus on doing its job better.

Last week, I listened to the secretary of the Department of Health, Michael Scanlon, give an honest and robust defence of his department at the Siptu nursing convention in Wexford. In the course of it, he acknowledged that "it is a nightmare trying to find your way through our health system, even when you know your way around it". When the secretary of the department finds the system nightmarishly opaque, is it surprising that we can't set realistic targets and meet them? And though Scanlon would not accept this, his Minister has made the nightmare much worse by playing Dr Frankenstein at the creation of the HSE and by adding a third for-profit system to an already tangled two-tier system.

Last week, a report from the Adelaide Hospital Society calculated the cost of a "Rolls Royce" insurance-based health service, with "timely access to hospital consultants" and free primary care would be just over €2 billion more than we currently spend. Such a price would be well worth paying, if we had a minister with the vision to make it happen. Perhaps a reverse takeover of the South by the North might be the way to get one.

'Why can Michael McGimpsey deliver stark improvements in less than two years while Mary Harney fails to in 3½ years?