Eithne Donnellan, Health Correspondent, reviews the HSE's handling of the many ills of 2006
Earlier this month when voters were asked in a national opinion poll if the establishment of the Health Service Executive (HSE) and the abolition of health boards had resulted in an improvement in the health service, more than half of those who responded said it had not.
Some 58 per cent said the organisation, now responsible for the day- to-day running of the health service and its multi-billion euro budget, had not improved the running of the health service while 25 per cent said it had improved things and 17 per cent had no opinion.
The HSE can hardly have been taken aback by the verdict of voters on its performance, with The Irish Times/mrbi poll coming as it did at the end of a year when the organisation battled to convince the public it was taking seriously a range of issues from the policing of nursing homes to tackling rising rates of hospital-acquired infections.
There were as always promises that these were top-priority issues for the HSE but when it came down to it, the reality seemed different.
Take, for example, the number of times the HSE said this year it now had a "robust" nursing home inspection system in place. Then last month Dr Paula Gilvarry, the vice- president of the Irish Medical Organisation (IMO) who herself carries out nursing homes inspections, revealed that proper nursing home inspection teams were still not in place in all areas.
Then there was the debacle over the publication of the report on Leas Cross, the private nursing home in North Dublin which was forced to close after conditions in it were highlighted by an undercover camera on RTÉ's Prime Time Investigates.
The long delay in the report's publication was blamed by the HSE on its author Prof Des O'Neill for not giving anyone mentioned in his report an opportunity to respond.
When O'Neill stood his ground and pointed out that he had completed his report in line with the terms of reference he had been given, the HSE was forced to admit the terms of reference it provided should have been different.
Meanwhile, the HSE insisted the delay in publishing the report didn't prohibit it from taking steps to implement its recommendations once it received them in May (the report was finally published in November). In June it announced it had formed a working group to plan for the implementation of recommendations contained in the O'Neill and other reports carried out on Leas Cross.
But when asked who was on the working group the HSE said it could not reveal the names of members as this was "an internal HSE process".
This new level of secrecy within the HSE has been condemned, particularly by politicians who claim it is becoming more and more difficult to get replies to simple questions from the organisation. Over the past year they say they have been left months waiting for replies to parliamentary questions.
A further example of this secrecy was from comments made by Prof Brendan Drumm, the HSE's chief executive, when he was asked at the Oireachtas health committee in March how many deaths had been caused by MRSA. He said to give the figure of how many people died with MRSA to the public would be "almost unfair and would frighten people".
More frank was Dr Kevin Kelleher, director of population health with the HSE, when he appeared before the same committee in February. He said the health service "probably" wouldn't be able to cope in the event of a flu pandemic, which will inevitably occur at some stage, just nobody knows when.
In July when new figures showed no improvement in MRSA infection rates among patients in Irish hospitals, with some 592 bloodstream infections reported in the previous 12 months, it emerged the HSE had been given funding earlier in the year to recruit 52 additional infection control staff but hadn't even begun to recruit them at that stage.
The day after the figures were published it said "recruitment for the 52 posts is now proceeding".
And when the Lourdes Hospital Inquiry report was published in February there were commitments to action all round - the report's recommendations were going to be taken seriously and acted upon. However, two months later when the author of the report, Judge Maureen Harding Clark, addressed a conference in Dublin she sharply criticised the HSE for failing to implement some of her recommendations.
There has been much criticism too during the year of the decision, taken by a taskforce representative of the HSE and others, to build the new national children's hospital - into which the three existing children's hospitals in Dublin will be merged - on the site of Dublin's Mater hospital. However, the HSE says the decision, endorsed by Government, will see the new hospital, which it wants co-located with an adult teaching hospital, provided more swiftly.
The organisation was dragged into controversy too over its plan for the reorganisation of hospital services in the northeast and in the west. The plan to remove certain services from Monaghan General Hospital has seen locals take to the streets in their thousands in protest.
In Roscommon, a threat by a local Fianna Fáil TD, Michael Finneran, to run as an independent in the general election unless a proposal to remove inpatient surgical services from Roscommon County Hospital was withdrawn has seen the HSE going back to the drawing board to commission another review of how services there should be organised.
But through it all Drumm has made it clear he is determined politics will have no bearing on how hospital services are organised into the future; he insists patient safety will be the decider.
Meanwhile, eyebrows were raised at reports in May that Drumm was getting a €32,000 bonus, in addition to his package of nearly €400,000 a year, at a time when management in some HSE regions were considering the introduction of spending restrictions to make up for significant budget overruns by hospitals in the early part of the year.
Several other issues which could also have brought the HSE into fire-fighting mode in the past 12 months have been bounced forward to 2007. Decisions on contentious issues such as the further roll-out of PPARS, the controversial computerised payroll and human resources system for the health service, and the thorny question of bed capacity and whether our acute hospitals need more beds, have been put off until next year.
A fresh review of bed capacity was announced last March but the HSE ended up tendering twice to get a consultancy firm to carry it out and it's only in recent days that a company was awarded the contract to do the job. The review is now not due until next April.
While in many ways 2006 was a year when the HSE seemed to be constantly trying to put out fires, there were positive moments also, most notably the results of the second hospitals hygiene audit which showed dramatic improvements in hygiene standards in almost all hospitals.
It also managed to finally get a GP co-op up and running in north Dublin, and the Ballymun health centre finally opened in north Dublin after lying idle for three years. In addition, the HSE scheme to begin repayment of illegal nursing home charges began in August.
It's generally accepted that there have been improvements in the numbers waiting on trolleys in A&E departments in several hospitals, if not in them all. However, there are concerns that in some cases, A&E patients are being moved to beds which would otherwise be used for patients undergoing elective surgery, resulting in more elective patients being cancelled.
Time will tell if this is the case and, if it is, it may present as a further headache for the HSE in 2007.