Mary Harney's aim to improve the health service looks a long way off target. Miriam Donohoe, Political Staff, reflects on her past year in office
When she took over as Minister for Health in September 2004, Mary Harney set out her ambition in an address to the Dáil: "The one thing I want for the country I love is to have a health service that is accessible to every citizen, regardless of their wealth."
Her decision to take on the job, despite the reservations of many of her Progressive Democrat colleagues, won her admiration in many quarters and she began her term in Health with the support of those who felt uncompromising political decision-making was needed to push reforms through.
She set out five main aims: the improvement of the Accident & Emergency service; the reduction of waiting lists; the prioritisation of cancer services; more for elderly care; and a re-negotiation of the consultants' contract.
Harney made it clear she didn't expect to solve all the health service problems before a general election, but she expressed confidence that with the proper approach, significant progress could be made.
Two years on, and with just six months to go to the election, the Minister for Health has failed to shake off the perception that ours is a health service lagging behind what citizens in other developed countries enjoy.
That perception was borne out by the recent Irish Times/TNS mrbi opinion poll in which a clear majority of voters said they believed her appointment as Minister for Health had not led to an improvement in the health service.
The poll must have made for depressing reading for the Minister and her team. Some 58 per cent of people polled said there had been no improvement in the efficiency of the health service under her stewardship; 30 per cent of voters said it had improved; and 12 per cent had no opinion.
When asked if the establishment of the Health Service Executive (HSE) and the abolition of the health boards had resulted in an improvement in the health service, voters were even more negative with only 25 per cent saying it had and 58 per cent saying it had not.
This is despite the fact that the Minister for Finance, Brian Cowen, has given Harney all the money she wants for extra services. A further €400 million was allocated in the Budget, bringing the total spend for 2007 to €15 billion.
Part of the problem is the sheer scale of the health service and the nature of the problems within it. Some are dealt with by extra resources, but many others are more complex, and not as easily solved. Then, there is the political pressure applied by local hospital groups.
Nowhere are the challenges more obvious for Harney than in the nursing home sector. The Prime Time expose of conditions in Leas Cross Nursing Home in 2005 opened up a whole new area of controversy in the health service.
Eighteen months on, the Minister is now only at the point where the fall-out from it is being dealt with by legislation. The Health Bill 2006, which allows for the establishment of an independent inspectorate for private and public nursing homes, was published before Christmas and is expected to be law by Easter.
There was great expectation that Harney would be in more positive territory in relation to the funding of nursing home places and in mid-December she published her plan for nursing home residents to pay for their care "beyond the grave" through a levy that would be equal to 10 or 15 per cent of the sale price of their homes.
But already there are signs of a major backlash, with some Fianna Fáil TDs voicing unease at the plan to use 15 per cent of the family home value to pay for long-term nursing home care.
Mary Harney told TDs at the last Fianna Fáil parliamentary party meeting before the Christmas break that in the initial years the State would carry the bulk of the cost for long-term high-dependency cases at about €700 million a year, and that the 15 per cent charge would be levied only on the estate of a deceased patient, and only then if it was appropriate to sell the house.
She says the 15 per cent could raise about €100 million a year towards the cost of long- term care when it is up and running.
However, there is a worry about the politics of this so close to an election. Some TDs have questioned if it is worth embarking on what might prove to be controversial legislation so near polling day when such a small amount is involved.
The decision of health insurer Bupa to pull out of the Irish market over risk equalisation also presents a headache for Harney, with accusations that she didn't do enough to compromise or stagger the introduction of community rating over a number of years.
However, it hasn't all been bad for the Minister. She oversaw the establishment of the HSE and there has been a noticeable decline in reports of over-crowded accident and emergency departments and patients on trolleys. But the Minister is only too aware that she is only one outbreak of the winter vomiting bug away (which would close a number of beds) from another controversy that, fairly or unfairly, will present the health service she presides over in a negative light.
There is also the perception that over-crowding is being tackled at the expense of elective surgery where the cancellation rate is growing.
Political sensitivities with local pressure groups has led to a big kick to touch on which hospitals will provide cancer procedures as part of the plan to establish regional cancer centres. She has set up an implementation group to look into this, nicely deferring the issue until after the general election.
The National Treatment Purchase Fund, on the other hand, has been one of the successes reducing the waiting times for non-emergency operations.
However, the biggest task facing Harney between now and the summer is the reform of the consultants' contract. In an interview with The Irish Times a year ago, Harney promised that if an agreement on a new contract could not be reached by Easter of 2006 she would push it through anyway. However, this never happened.
The Government and consultants recognise that there is a need for a minimum of 1,600 new posts but the Government won't agree to fund this under the current contract conditions.
The contract is the key to everything. But the talks between health service management and the consultants are on the verge of collapse and most observers are pessimistic about a successful outcome.
Any attempt by Mary Harney in the absence of agreement to force through a new contract will lead to ructions in the hospital system with industrial action by senior doctors not out of the question.
This could come at the same time as a pay battle with 36,000 nurses reaches a climax.
The road to the general election could be a rocky one for Minister Harney.