Analysis: Even before the Hanly report sailed into stormy waters last week with a senior Cabinet minister expressing reservations about the effect its implementation would have on a hospital in his own back yard, the report was already in trouble. Meeting EU obligations will prove a challenge, writes Eithne Donnellan
A groundswell of opposition was building at meetings across the State, not just in Ennis and Nenagh, to its plans to replace accident and emergency units at smaller hospitals with minor injury units, which would be open from about 8 a.m. to 8 p.m.
Hanly has only made recommendations for two pilot regions - the mid-west and east coast area health boards - but it does say that its blueprint should be used to reorganise hospital services elsewhere. Those plans for other regions will be contained in Hanly 2, which will not be published until after the local elections next year.
Communities across the country with local hospitals aren't waiting for Hanly 2 to voice their opposition. There have already been protest meetings attended by hundreds of people in areas such as Ballinasloe and Athlone, and the presence of hospital consultants at these meetings, warning the public of the dangers of reduced A&E services, will make it very difficult for the Government to implement the report. The public will ask why they should believe a politician over their local hospital consultant.
Recognising local concerns, the Taoiseach, Mr Ahern, said yesterday that local communities would be consulted before the Hanly report was fully implemented, which he suggested would take 10 years.
This may be the case but the problem is that the main purpose of Hanly was to reduce the working hours of junior doctors within the next six years in order to comply with a new EU directive. It dictates that non-consultant hospital doctors (NCHDs) must not work more than 58 hours a week by August next year and no more than 48 hours a week by August 2009.
At present, NCHDs work an average of 75 hours a week which, apart from affecting their health and well-being, is potentially unsafe for patients.
The European Working Time Directive (EWTD) places a legal obligation on the State to reduce their hours and failing to do so will leave the State open to having large fines imposed on it.
Therefore, as the chairman of the National Taskforce on Medical Staffing, Mr David Hanly, put it, doing nothing is not an option.
Hopes of immediate talks between the Irish Medical Organisation (IMO) and the Health Service Employers' Agency (HSEA) in an attempt to reduce those working hours once the report was published were dashed when the IMO said it would not enter talks with an agency (the HSEA) that it claimed had failed to honour previous agreements.
Yesterday, however, there appeared to be some progress when, at a meeting of the National Joint Council, a body representative of health service employers and the Department of Health as well as health service unions, it was agreed in principle that both sides would look at agreeing dates to attend the Labour Relations Commission (LRC) to discuss junior doctors' working hours.
The IMO said the first item on the agenda would be previous NCHD agreements that had not been honoured.
The chief executive of the HSEA, Mr Gerard Barry, said the fact that both sides would meet was an important development but he conceded meeting the requirement of the EWTD would not be easy.
"It's going to pose a real challenge to us and the IMO," he said.
He believes, however, if there is "a huge combined effort" by both sides, they will be able to meet next August's deadline.
Apart from the need to reduce NCHDs' working hours, the HSEA has been concerned at the overtime bill for the State's 4,000 junior doctors, which runs to more than €200 million a year. If the hours of the doctors are to be cut, the IMO will be seeking compensation.
Not surprisingly, the HSEA has a difficulty with this. So, even if talks begin at the LRC in the next week or two, reaching agreement could be a long way off.
Then there's the need to renegotiate consultants' contracts so that they will work around the clock, in line with Hanly's proposals. The Irish Hospital Consultants Association will have a preliminary meeting with the HSEA on this issue on Thursday week but it has warned it will not negotiate an "interim contract" for consultants working in the two pilot regions, where implementation of the report is due to take three to five years.
At this stage, the IHCA believes the requirements of the EWTD will not be met by next August. Its secretary general, Mr Finbar Fitzpatrick, points out that the Hanly report dictates what should happen to reduce hours in just two regions, but the EU directive applies to the whole State.
Furthermore, the implementation of Hanly requires time and money "of which we have neither at the moment", he says.
The Department of Health, at the publication of its Estimates last week, said funding was guaranteed for "initial steps" in the implementation of Hanly in the two pilot areas. The amount was not disclosed.
Given its record of funding the implementation of other reports, such as the National Health Strategy and the primary care strategy, one couldn't blame people such as IMO president Dr Joe Barry for being sceptical about the Department's plans now to fund Hanly.
"People in the health service are working in a system where targets are just not being met left, right and centre," he said, adding that Hanly couldn't work if primary care wasn't first properly funded because it "assumes primary care will fill the gaps".
With targets "left, right and centre" not being met, nobody should be surprised if the next target of meeting the EWTD - which incidentally has already been implemented in 10 of the EU's 15 member-states - by next August is also missed.