According to the organisations that represent patients throughout the State, the new goverment will have a long list of healthcare commitments to honour, writes Theresa Judge
Hopes for improved services will be raised after an election campaign in which health issues dominated. However, many organisations representing patients and health service staff have a long list of what the new government's priorities should be.
It is also stressed that much of what needs to be done has already been promised in various strategies and it is a question of ensuring the HSE implements recommendations with greater urgency. For example, the Irish Cancer Society has been stressing for some time the importance of appointing a national cancer control director, a post promised since last summer.
"Progress on the implementation of the national cancer control programme will only happen once this appointment is made," says John McCormack of the society.
The cancer society is also frustrated at the appointment process because the HSE must secure the Department of Health and the Department of Finance for the pay and terms of the job.
The HSE issued a statement at the end of March saying the post was about to be advertised but this has not yet occurred.
McCormack says this system "calls into question the HSE's ability to function as an autonomous body".
In addition to this appointment, he says the new government must honour the commitment to roll out cervical screening nationally by 2008 and to meet the December 2007 deadline to have BreastCheck in all regions.
The cancer society's other priority would be to have quality assurance guidelines - similar to those unveiled last week for breast cancer - produced for the other three most common cancers - prostate, lung and bowel.
Sheila O'Connor of Patient Focus says the new health minister should concentrate firstly on patient safety and quality of care. Implementation of the new Medical Practitioners Act should be an urgent priority and, thirdly, the minister should quickly appoint "urgently needed" consultants.
O'Connor says that too often when a mistake is made in someone's treatment they become "an embarrassment" and are "left in a corner".
Instead there should be a rapid response and set procedures to help ensure a patient subsequently gets the best care possible.
The Irish Heart Foundation has four main priorities for the new government, including substantial investment to develop specialised stroke units around the State and the appointment of 37 additional consultant cardiologists. It points out that with 47 cardiologists in the Republic currently, the rate is 11 per million compared with an EU average of 35 per million.
Two other priorities relate to the implementation of reports produced in previous years - the 2005 National Taskforce on Obesity and the 1999 Cardiovascular Health Strategy. The foundation says that two years after the obesity report "little has happened to implement any of its recommendations" and it wants action on the marketing of unhealthy food to children, food labelling and nutrition claims.
In 1999 it was stated that the cardiovascular strategy would cost €220 million to implement its 211 recommendations.
"To date only €60 million has been invested, with the majority of this between 1999 and 2003. In 2004, 2005 and 2006 little was made available to support the strategy," the heart foundation says in a statement.
For the Irish Kidney Association, a priority is to restart the living transplant programme which chief executive Mark Murphy says is still "semi-suspended".
Measures are currently being taken to restart the programme over the coming months. Murphy also wants the new government to ensure that a report completed last December - the national renal strategy review - is published quickly and implemented. He says the HSE has had it for six months now.
To implement the report will require the doubling of dialysis services over the next five years as the number of people in need of dialysis is growing by 10-15 per cent a year. Ireland, he says, is only playing catch-up with the rest of Europe in detecting the number of people with renal disease - without treatment, such people can suffer heart attacks or strokes.
Another report waiting to be published is that of the HSE working group on cystic fibrosis. Its chief
executive, Godfrey Fletcher, says this report will provide "the roadmap on which the future of CF services will be based" so it is very important to get it released and implemented.
Ireland has the highest rate of cystic fibrosis in the world and the very poor standard of services was highlighted during the election campaign.
Funding for specialist staff is vital if services are to improve and Fletcher says commitments to increase funding must be met. A total of €10 million per year by 2008 has been promised, an increase from 4.78 million in 2006. Some 80 per cent of 56 posts promised last year have now been filled, Fletcher says.
There was a frustrating delay because although funding was sanctioned for additional doctors and nurses, staff ceilings in individual hospitals meant they were not appointed.
The other major issue is facilities to ensure CF patients can get direct admission - without going through A&E - to single rooms. Currently there are no dedicated stand-alone CF units and Fletcher says the first priority is to have one opened at St Vincent's Hospital in Dublin, followed quickly by one in Cork, and then Galway. He now wants written commitments, as opposed to verbal ones, to open these units.
Fletcher says another priority is to establish an effective organ recovery system to increase the number of CF patients who can get lung transplants. Only six patients received transplants last year although some 25 people were waiting.
He says a lot of potential donors are being lost "because we don't have the means of identifying and recovering the organs".
Following the nurses' long and acrimonious dispute, the Irish Nurses Organisation (INO) says its first priority remains the creation of a health system that is equitable at the point of access with a single waiting list where need rather than ability to pay determines treatment.
General secretary Liam Doran says this means the end of the two-tier system where ability to pay means quicker access and treatment by more experienced doctors.
The INO is in favour of public-only consultant contracts but Doran stresses that these must be negotiated rather than imposed.
He says the INO's second priority for the new minister would be "a move away from what has been a medical model of care". The service must fully use the expertise of the full range of professionals working in the health service, including nurses, midwives, physiotherapists, speech and language therapists, dieticians, etc. These professionals should be given autonomy and responsibility and also made accountable, he says.
The third priority for the INO is the implementation of the agreement reached with the HSE which ended its dispute last week.
He wants "an early recognition" of the issues facing nurses and midwives by paying them the same as other health professionals and by giving them the same working hours. This would be in the context of reform and an expanded role for nurses and midwives, he adds.
The Irish Hospital Consultants Association (IHCA), currently in dispute with the HSE and the Government over new contracts, lists a number of areas it believes need to be tackled. The first of these relates to extra hospital beds - it says the EU average is 4.4 beds per thousand population while it is 2.9 beds per thousand here.
The IHCA says there is a contradiction between what the HSE and the Department of Health is saying in relation to the number of beds needed and that this must end. In recent reports the HSE is challenging the idea that a lot more beds are needed in the system.
The IHCA says a second priority is for more services for people coming out of acute hospital care - home care, long-stay and rehabilitation facilities and community services.
The association also wants the new minister to address the "alientation of key hospital staff" and criticises the "totally centralised" decision-making within the HSE.
Similarly, director of industrial relations with the Irish Medical Organisation Fintan Hourihan has a long list of priorities for the new government. These include a commitment to implement the primary care strategy - due to the fact that primary care has been "neglected"- and to increase the number of full medical cards.
Negotiations on new consultant contracts should be resumed as a matter of urgency and the advertising of new posts should be based on agreement with representative bodies.
He says there needs to be a critical evaluation of the way health reform is being delivered and "an appraisal of why the HSE is in conflict with so many groups". Like the IHCA he stresses the need for more acute hospital beds, more rehabilitation units and specialised stroke units.