Is health to be the defining issue for this Government's second term? It is certainly the issue on which the electorate has felt most deceived, after cutbacks immediately succeeded an election fought on the promise of massive investment. Now, after a week of great busyness, of promises of reform, of shadow-boxing with the consultants, is the reality of Irish healthcare really going to change?
If the Government implements its promised structural reforms, local politicians and administrators will experience change, but will patients receive improved services? The Government has yet to supply a convincing answer to this question. If the recommendations of the as yet unpublished Hanly report, described in this paper on Friday, were implemented, patients would undoubtedly experience change. Hospital services would be concentrated in regional "centres of excellence". Smaller hospitals would not close but would no longer offer acute emergency care. Much more patient care would be delivered by fully-trained hospital consultants. While patients might be obliged to travel further for care, their care would be of a higher quality.
None of this will happen without political will and dexterity. The Government will have to be much more decisive about the location of hospital services than it was about its fudged spatial strategy. It will have to win over local communities, who fear disimproved access to care. It will have to convince hospital consultants to change how they work.
Change of this magnitude cannot be effected without up-front investment, even if eventually a more streamlined service may deliver better value for money. Regional centres of excellence will not be excellent without investment. If people must travel further to hospital, they will require better transport and ambulance services. If local hospitals are to change their nature, then primary care must improve. Every patient who needs a stitch will no longer be able to travel to hospital for it. General practitioners must be resourced to offer such care, in co-operation with local hospitals.
Without investment, the people will not support these reforms. And if by the next election the Government has not convinced that its plans will deliver better care, the election of independent hospital candidates could scupper reform. At a minimum, the Government needs to secure the endorsement of the social partners for its plans. Arguably, it should seek cross-party support.
While the contract of employment of hospital consultants has become the overdue focus of political attention, consultants might legitimately counter that successive governments agreed their contract and designed the two-tier system of hospital care with its fostering of fast-track access for the privately insured. Despite sabre-rattling about vested interests, the Government has disclosed no plans for dismantling that system. It may fear the electoral power of the privately insured much more than the industrial muscle of consultants. Ending two-tier care would require the privately insured to take their place in the queue for public hospital care. Only increased investment would offer them and all patients the reassurance that that queue would be a shorter one.