A commitment by Health Service Executive (HSE) chief executive Brendan Drumm to publicly identify, within 48 hours, those centres for breast cancer treatment that operate to standards of best practice is a significant and courageous response to the crisis of confidence that besets the system. It will make him no friends, while antagonising powerful vested concerns. But it places consumer interests at the heart of the health system and allows patients to make informed choices about their treatment.
A succession of faulty cancer diagnoses at Portlaoise hospital is causing immense distress to individuals and families in that community. That situation could be replicated elsewhere because of inadequate scanning equipment and a shortage of specialist personnel. By identifying those centres the HSE is prepared to stand over for their quality of service and multi-disciplinary teams, Professor Drumm will be inviting patients to vote with their feet. At the same time, he has provided assurances that basic cancer care services - such as the provision of chemotherapy - will continue to be provided at all existing centres.
No magic wand can transform our health services overnight. The system is a product of decades of political ineptitude and cowardice that allowed vested interests gain control to the detriment of patients. Political attempts at reform were botched, first through the establishment of an excessive number of health boards and then by reversing that bloated management structure into the HSE. It is no surprise that negotiations on a new hospital consultants' contract are still dragging on, with Government interests in retreat, after six years.
Professor Drumm has been two years in the job and, whatever his failings, he is committed to providing the public with better quality healthcare and is not afraid to challenge vested interests. That is a huge plus. But in a society where the transfer of blame and responsibility has been elevated to an art form and the Government avoids confrontation, he should step lightly. Reform is urgently required and generally acknowledged. But a commitment to unpopular choices is in short supply, as was evident when the HSE chief executive briefed members of Houses of the Oireachtas yesterday.
A decision on the location of a new national children's hospital; the identification of eight specialist cancer care centres; the provision of out-of-hours GP cover; the development of primary care and general improvements in A&E hospital services represent important advances. But they are "works in progress". A great deal of commitment, imagination and negotiation will be required to bring them to fruition. In the meantime, things will go wrong. Services and work practices will have to be overhauled and integrated. But there can be no turning back from reform that sets as its goal the establishment of centres of excellence and the provision of services that reach standards of best international practice.