The Cabinet will discuss the fallout from the Michael Smith affair tomorrow,reports Mark Brennock, Chief Political Correspondent
The sight of Fianna Fáil's two TDs for Clare coming out in support of the 15,000-strong protest on Saturday against the proposed removal of some services from Ennis General Hospital will have looked grim to the Minister for Health, Mr Martin.
Mr Tony Killeen TD was among the 15,000 protesting against any reduction of services provided in the local hospital. Local party Senators Brendan Daly and Timmy Dooley showed up too. Síle deValera was unwell but sent a message of support.
Opposition deputies from Limerick, Cork, Tipperary and as far away as Mayo, Sligo and Cavan/Monaghan were there. In a fortnight's time there will be a repeat demonstration in Nenagh concerning the hospital there. There was talk at the weekend of forming a national alliance to campaign against the recommendations of the Hanly report, which prescribed the reduction of Accident and Emergency services in some local hospitals and the concentration of such facilities in regional centres of excellence.
Government sources say the Cabinet is expected informally to discuss the fallout from the Smith controversy and Saturday's protest in Ennis. Against the background of a growing momentum against the most politically difficult aspect of health service reform, the Minister for Health Mr Martin will be keen for some renewed signal of determination to proceed with the Hanly reforms.
One Government source and several Fianna Fáil sources yesterday expressed unhappiness with Mr Smith's statement on Friday, saying it was inadequate. "It was far from abject," said one. "He repeated his position," said another. "He just regretted the fact that everybody except him saw his remarks as being against Government policy."
Another Government source, however, felt the issuing of the statement was a good outcome for Mr Ahern. If the statement hadn't been accepted "there would have been a resignation or a sacking, Smith would be a martyr and Hanly would be the biggest political issue for a long time to come", the source said.
Mr Martin is expected now to show determination to press ahead with Hanly in the two areas chosen for "pilot" implementation - the east coast and mid-west health board regions. Hanly says there should be a single major hospital with a full range of emergency, trauma and other services available 24 hours a day in the mid-west (Limerick Regional Hospital) and east coast health board areas (St Vincent's in Dublin). All other hospitals in those regions would concentrate on treating minor injuries and doing elective day care procedures.
Persuading local people to accept such changes to their local hospitals - including the loss of A&E services - is the core political difficulty. It was exacerbated by Mr Smith's decision to identify himself publicly with the resistance to plans to take services from his local Nenagh hospital.
The Minister is to press ahead. Membership of the implementation groups is to be announced in the next few weeks. They will then have some nine months to decide on precise details of reforms, such as what medical specialities to move to the regional centres of excellence, which to leave in local hospitals, what staff will be needed, how many ambulances, where will they be based, how will they be staffed, how many new consultants must be appointed.
In theory, these recommendations will be made in time for the allocation of the resources in next year's Government book of spending estimates. If local opposition is to be overcome and communities are to be persuaded that the changes are good for them, the Government must convince them that resources will be provided.
For on the one hand, proponents of reform argue that investment in new hospital beds and facilities cannot take place until there is certainty over whether all, or some, of Hanly is to be implemented. They say that large sums of money - promised in the Government's own health strategy and Fianna Fáil's 2002 election manifesto - cannot be invested in capital development at hospitals until we know which hospitals will be doing what.
But, on the other hand, no local community or their political representatives will accept downgrading of their local hospital until they are convinced there will be substantial investment in local non-acute medical facilities, GP care and the promised upgraded ambulance service.
In parallel with this campaign to convince the public of the benefits of Hanly, Mr Martin is to begin immediate discussions with doctors' representative organisations. Their agreement is needed to set up a new system of doctors working hours after a recent EU directive laid down that the hours worked by Non Consultant Hospital Doctors have to be cut to 58 hours a week by next August, to 56 hours a week by August 2007 and 48 hours a week by August 2009.
The Hanly group is also to start work on the details of how to implement its principles in the remaining health board areas.