Martin Wall looks at the highs and lows of the health sector over the past 12 months
JANUARY
Just weeks after the Tánaiste and Minister for Health, Mary Harney, announced with great fanfare her 10-point plan to tackle the ongoing problems in accident and emergency while the Irish Nurses Organisation (INO) claimed that the overcrowding crisis had reached record levels.
On January 11th, the INO claimed that there were 365 patients on trolleys in accident and emergency units around the State. Some of the worst hit hospitals were Letterkenny, Tallaght and Beaumont where more than 30 patients were queuing for beds.
The INO claimed 28 patients in Wexford were on trolleys despite the fact that its A&E department can only accommodate four at a time.
The nurses organisation subsequently embarked on a high-profile trolley-watch campaign which kept the concept of over-crowding in accident and emergency departments in the news for several months.
The Department of Health claimed credit for easing pressure on accident and emergency facilities through the introduction of various measures. However, the number of patients inappropriately occupying beds in public hospital after the completion of the acute phase of treatment remained stubbornly high.
FEBRUARY
This month saw the State on the brink of industrial action by hospital consultants which could have affected 50,000 patients per week.
The threatened industrial action by consultants was in protest at Government moves to introduce a new insurance system for senior doctors without their agreement.
Consultants feared that they could be left in the middle of a dispute between the Government and the UK-based international medical indemnity body, the Medical Defence Union (MDU), over who should pay for historic liabilities arising from incidents that pre-dated the introduction of an effective State insurance scheme.
The MDU had said that it would not cover a number of such cases taken against consultants. Consultants argued that some doctors could be left penniless despite having paid for indemnity cover all through their careers if they were held personally liable in any such action.
Feelings were running so high that it prompted the Irish Hospital Consultants Association to drop its long-standing no-strike policy.
An uneasy peace was eventually agreed between the Government and the hospital consultants which headed off the threatened strike. The central issue of who should pay for the historic liabilities is expected to be determined by the courts.
However, the row delayed the negotiation of a new contract for consultants - a central feature of the Government's overall healthcare reforms for nearly two years.
MARCH
March saw the closure of the inquiry into the retention of organs by hospitals. The inquiry, chaired by senior counsel Anne Dunne, had run for five years and cost around €20 million. However, for families who had waited for years to find out why their relatives' organs had been retained and for what purposes, there was to be no immediate answer.
The Government had rejected a proposal by the inquiry for an extension of time and insisted that it would have to complete its work by the end of March.
On deadline, the inquiry submitted nearly 60 boxes of material to the Department of Health.
However, following an examination of the material by lawyers retained by the Attorney General, the Cabinet decided that the report could not be published. No satisfactory explanation was ever given for this decision.
Harney said it was a great pity it took so long to produce the official report on the retention of organs by hospitals. She also maintained that lessons needed to be learned from the experience of the Dunne inquiry.
The Government asked an expert in medical ethics, Deirdre Madden, to draw on the material generated by the Dunne Inquiry and to produce a new report by the end of the year.
APRIL
April saw public hearings into the biggest health scandal of the year, the illegal charging of elderly patients for their stay in long-term public institutions.
The Secretary General of the Department of Health, Michael Kelly, became the most high-profile casualty of the controversy when the Cabinet removed him from his post and transferred him to the Higher Education Authority, in the aftermath of a report into the controversy by former senior civil servant John Travers.
Travers found that the illegal charging had dated back nearly 30 years - long before Kelly became a senior official in the Department of Health.
Harney told an Oireachtas Committee that she had been tempted to sack Kelly several months before but waited until the outcome of the Travers report.
She claimed Kelly had withheld information in a report he prepared for her on the nursing home charges the previous December.
Kelly said he accepted any responsibility for any corporate failings of the department in relation to how the nursing home charges issue was dealt with, but strongly denied that he deliberately withheld key information on the issue from the Tánaiste.
In evidence to an Oireachtas Committee, Kelly said he had informed the former minister Michéal Martin of the problem on two occasions.
Martin denied that he had ever been told. He and his advisers accepted that they had not read briefing material prepared on the issue for a meeting with chief executives of the former health boards.
The findings of the committee on responsibility for the controversy, which will cost around €1 billion, were largely inconclusive.
MAY
The State's first lung transplant was carried out on a 56-year-old woman from Limerick at the Mater Hospital in May.
Speaking after her discharge from hospital, Veronica Doyle said that prior to the transplant she had been on oxygen 24 hours a day.
She couldn't walk from the bedroom to the kitchen of her home in Abbeyfeale and she found it difficult to put on her socks in the morning.
However she said that after "a miraculous operation" she was back walking, laughing and able to dress herself.
She said that she was speaking publicly "because I'm so grateful to be given a chance to a new lease of life. I also want to give others who are in the same position as me hope .
"I found it very difficult to do the basic little jobs that everyone else would do. Recently, I even found it difficult to bring my hot-water bottle from the kitchen to the bedroom. I couldn't lift it down.
"I haven't walked on my own driveway for nine years . . . so I'll be looking forward to that. I can walk out the hospital door, I can wash my hands, I can wash my teeth, I can dress myself. To me it's a pure miracle really. It still hasn't sunk in how wonderful it is," she added.
A second transplant procedure was carried out in the Mater in September.
JUNE
June saw the fall-out from a major documentary broadcast, filmed undercover by RTÉ television's Prime Time, which highlighted poor conditions and treatment of patients at a large nursing home, Leas Cross, in north Dublin.
That month, the Health Service Executive announced it was withdrawing public patients from the facility - a move which ultimately led to its closure later in the summer.
The documentary prompted a review of how the State monitors standards in nursing homes. A separate review of the cases of 95 people who died at Leas Cross was also commissioned by the Health Service Executive. This is to be carried out by a leading consultant geriatrician.
Another report, carried out by former Blood Board chief Martin Hynes, into the death of a 60-year-old man who died shortly after being transferred to Leas Cross found that the nursing home, the disability service provider St Michael's House and the former Northern Area Health Board must together bear responsibility for what happened.
The report says Peter McKenna, who had Down syndrome and Alzheimer's disease, was "let down by the system".
McKenna had been transferred from St Michael's House where he had been based for more than 20 years.
In Leas Cross, McKenna was placed alone in an upstairs bedroom which had a call bell he could not use.
There was just one nurse at night time in the home looking after him and more than 30 other patients.
McKenna, according to the report, was diagnosed with a urinary retention problem and was taken to the A&E unit of Beaumont Hospital on October 9th, 2000, and had a catheter inserted. He was sent to Leas Cross the next day.
He returned to Beaumont for an appointment on October 12th but missed a further appointment to have the catheter removed on the 16th, the report said. However, Leas Cross claims this was because no bed was available for him in Beaumont that day.
McKenna had to be rushed to the hospital's A&E unit on October 22nd and he died later that day. Doctors there believed his condition had deteriorated over a number of days. He was dehydrated and his level of hygiene was poor.
The cause of his death was blood poisoning.
JULY
In July the Government announced radical proposals to develop private hospitals on the campuses of public hospitals.
The Tánaiste said the move would free up 1,000 beds which were earmarked for fee-paying patients in public hospitals.
It later emerged the Government believed these 1,000 beds would be counted towards the provision of the 3,000 additional acute hospital beds promised in the 2001 health strategy. The move sparked a widespread debate over the summer about the appropriateness of private sector involvement in healthcare.
The Government is now to commission a report into the number of acute beds the health system requires.
Harney said the initiative would ensure greater capacity for public patients, a more innovative role for the private sector and more efficient use of public and private resources. However, the move to re-designate the existing private beds in public hospitals will cost the Department of Health around €145 million in lost income.
AUGUST
The Health Service Executive finally secured a chief executive after the professor of paediatrics at UCD Brendan Drumm finally took the job.
The €400,000-per-year post had originally been offered to the deputy chief medical officer in the UK, Aidan Halligan, who initially accepted it but later changed his mind before he started. Drumm was then offered the job in April. It was understood he had accepted it, pending the agreement of terms and conditions.
However, in early June, he announced at a press conference that he had refused the position as the HSE could not guarantee him an equivalent post to that which he held in Our Lady's Hospital, after his contract with the HSE expired. The Department of Health and the HSE Board later re-commenced negotiations with Drumm and a deal was concluded.
Two weeks later, it was announced that Drumm would be taking up the post after it was agreed that he would be able to return to his academic post in UCD at the level of professor, at the end of his HSE contract.
The Government also agreed Drumm could appoint a five-person "cabinet" of advisers to work with him. However, it insisted that there would have to be a public recruitment process.
In December, Drumm was dealt a blow when it emerged that the highly respected head of the National Hospitals Office, Pat McLoughlin, was resigning following a row with the Department of Finance over his remuneration package.
SEPTEMBER
In September, the way was finally cleared for 200,000 patients to receive one of the Government's new doctor-only medical cards.
The new cards had been announced the previous November but the scheme's implementation had been delayed by a series of rows with GP members of the Irish Medical Organisation.
A €93-million deal had been done between GPs and health service management on the doctor-visit card in the summer, but it unravelled in August following a dispute over fees to doctors, in respect of patients with the new cards who reached the age of 70.
The €93 million covered additional fees, back money and benchmarking payments which the GPs maintained that they were owed.
A new agreement was finally reached in late September and as part of the agreement a full-scale review of the GPs' contract with the State was to be carried out.
The Tánaiste had, on a number of occasions, voiced her frustration at the delay in securing agreement with GPs on the new doctor-only card. At one stage she appeared to suggest that if no deal was reached, the Government would pay money directly to patients to purchase their own care.
OCTOBER
October saw the new HSE chief executive Brendan Drumm involved in controversy when he questioned the generally accepted belief in the hospital system that there was a requirement for thousands of additional acute beds.
Prof Drumm told the annual conference of the Irish Hospital Consultants Association that the Republic of Ireland already had a higher percentage of acute hospital beds than the United Kingdom, despite having a lower percentage of the population aged over 65.
He said that if community services were made more population-based, provided services seven days a week and access improved to diagnostic facilities that it would take pressure off hospital services.
The Government's 2001 health strategy contained a commitment to provide around 3,000 additional acute beds over a ten year period. Around 800 of these are already in place. A further 1,000 will be freed up under the Government's initiative for private hospitals on public hospital lands. A new analysis of acute bed requirements is also to be commissioned.
NOVEMBER
November saw the publication of the first national audit of hygiene in hospitals which produced some distressing findings.
More than 90 per cent of Irish hospitals were found to be below acceptable hygiene and cleanliness standards, according to a major new report.
According to the audit, carried out for the HSE by a UK consultancy firm, the least hygienic hospitals in the country are Beaumont Hospital in Dublin, St Columcille's Hospital in Loughlinstown and Waterford Regional Hospital.
Mallow Hospital in Cork, St James's Hospital in Dublin and Crumlin Children's Hospital in Dublin were the top three cleanest hospitals, according to the audit.
The report shows that Beaumont Hospital A&E scored only 27 per cent in terms of the hygiene environment, 33 per cent for management of patient equipment, 59 per cent for hand hygiene and 50 per cent for disposal of linen, all in the poor rating of the audit score and well below what are regarded as acceptable standards.
Some areas of Beaumont did score higher - for example, hand hygiene in its intensive care unit scored 91 per cent - but in most categories, its departments fell below even the "fair" hygiene standard score in the audit. St Columcille's Hospital in Loughlinstown scored only 31 per cent for hygiene environment in its A&E and 55 per cent for hand hygiene in its A&E. Hand hygiene in St Columcille's surgical departments was only rated in the poor category, at 64 per cent.
In contrast, one of the top three scoring hospitals in the hygiene league table, St James's, one of the busiest hospitals in the State, scored 82 per cent for hand hygiene in its A&E and 100 per cent for handling and disposal of linen and 94 per cent for disposal of waste in the same department.
The Tánaiste said huge sums were spent on cleaning hospitals and the audit showed that those with the highest expenditure did not feature in the highest scores.
One notable feature of the report, according to the HSE, is the factors often cited as contributing to lack of hygiene, such as high bed occupancy, lack of a hospital microbiologist and contracting-out of cleaning services, were shown by the audit not necessarily to lead to poor hygiene.
DECEMBER
The controversy over the health service computer system which was originally to cost €9 million but ended up costing €131 million was highlighted in a report of the Comptroller and Auditor General
The introduction of the PPARs payroll and human resources system was suspended by the HSE in November pending a new review.
In his report published in December, the comptroller criticised the governance of the project and how it was delivered.
He revealed that there had been more than 2,500 separate variations in relation to payment, leave and working hours for staff under the old health board system,
The comptroller said that external consultants had been paid around €57 million for work on the project. He criticised the fact that there had not been fixed-price contracts with the consultants and that the State appeared to bear all of the risk.
The PPARs system is in place in three health regions and in St James's Hospital. A review for the HSE board to be completed in January will determine whether it should be extended to the rest of the State.