The health service needs long-term reform, but the coalition parties need short-term results. This health strategy lays out a seven-to-10-year "programme of investment and reform", but the Government needs to convince voters that reform can be delivered. To do this, some early evidence of change is politically vital.
So in the long term there is to be a £10 billion (€12.7 billion) investment, 3,000 new beds, greater eligibility for medical cards, the development of GP co-operatives, a National Hospitals Agency and a variety of other medium- and long-term changes.
But the emphasis in yesterday's presentation was on the short-term aims. After lengthy talks with the Minister for Finance, Mr McCreevy, in recent weeks, Mr Martin has got a Government commitment to fund a number of politically important and immediate measures.
The Opposition unanimously condemned the Government document yesterday as short term, lacking in real reform proposals and long on manifesto commitments to get them through next year's general election. In truth, the document does contain longer-term proposals for change and modernisation.
But the radical reform proposals on the political agenda have generally not been taken. And Mr Martin was at pains to draw attention yesterday, again and again, to the proposals for immediate improvement.
In his speech at the launch of the document he highlighted the promises to be fulfilled by the end of 2002: 650 new beds; adult waiting time for treatment below 12 months; child waiting time below six months; a "significant" number of new day-care, respite-care and residential places for people with disabilities; more GP co-operatives in place next year.
Such tangible results would ease political pressure on the Government on the health issue if delivered before the next election. But they are not due until the end of 2002, and with the election expected in May or June, the coalition parties can't wait that long. They will want public patients and the 80,000 health service staff to have noticed change for the better before they cast their ballots.
The key to political success, therefore, is to begin the implementation of these measures almost immediately. Mr Martin confirmed yesterday that he had secured a commitment to funding them, and that the new Treatment Purchase Fund, designed as a short-term fix to the waiting list problem, would receive £25 million in 2002. As for the precise cost of the other short-term measures, he said we would have to wait until the Minister for Finance's Budget speech on December 5th.
The Progressive Democrats staked their claim to a large slice of credit for the short-term measures yesterday. The new Treatment Purchase Fund, which will buy treatment for public patients on long waiting lists, is a PD idea and the party blew its trumpet loudly on the matter throughout the day.
The new fund will seek out capacity in the private hospital system in the State and outside it for patients awaiting treatment. By the end of 2002, the fund is intended to have ensured no adult will wait more than 12 months and no child more than six months for treatment; by the end of 2003 the maximum adult waiting time is to be six months, with three months for children; and by the end of 2004 no public patient will wait more than three months, it promises.
This innovative plan avoids making any political choice on the public-versus-private medicine argument. The PD plan will simply allow public patients on long waiting lists access to private care for a period. On its own it is not a long-term solution: Only increasing the capacity of the public health system to meet demand for treatment will provide one. Without such an increase in capacity, those waiting lists will simply build up again - under some future government.
That's what happened last time, when in the early 1990s the then minister Mr Brendan Howlin sourced treatment in Northern Ireland and Britain for patients on waiting lists. Fine Gael's Gay Mitchell maintained yesterday that the 3,000 new beds promised in the next decade would not be enough to prevent another buildup.
Many reform proposals on the political agenda for many years have not made it into the document. The radical, egalitarian option of abolishing the two-tier system and moving to a single waiting list has not been taken. Indeed Sinn FΘin's Caoimhgh∅n ╙ Caolβin pointed out that the PD waiting list initiative would involve more public money going into the private system.
There is no reform of the 30-year-old health board system, no "Dublin weighting" for nurses to attract them to the region of most shortage.
Fine Gael's spokesman Mr Gay Mitchell and Labour's spokeswoman Ms Liz McManus condemned the absence of reform. "Any long-term thinking has been sacrificed for short-term political needs", said Ms McManus. The Government is "pouring money into the same failed and tired system", said Mr Mitchell.
Labour has put forward a proposal for a new system whereby everybody would have private health insurance, and those who couldn't afford it would have their premiums paid by the State. In his speech yesterday the Taoiseach went out of his way to reject such a move, saying "the evidence demonstrates that any attempt to introduce a new system based on private insurance would result in major instability".
Thus one point of clear health-policy difference has emerged, with Labour having proposed such a system and Fine Gael indicating it would be open to examining the idea. But the political battle on health in the coming months will involve the Opposition seeking to condemn the Government on its record, and the Government seeking to change the perception by achieving results in a few short months.