The Minister for Health, Mr Martin, needs to clarify precisely what he means when he says that medical cover will continue to be provided overnight in acute hospitals affected by the Hanly reforms.
A similar form of words was used by the Taoiseach, Mr Ahern, at the Fianna Fáil Ardfheis, in an attempt to reassure party activists in advance of the local elections. But it is still unclear what late-night medical services will be provided within the hospitals, or whether doctors and consultants will be "on call" at their homes.
The Coalition Government changed its position on this issue in response to public pressure. Mr Martin admitted as much, two weeks ago, when he instructed those executives with responsibility for implementing reform in the East Coast and Mid-West Health Board areas to take account of the public debate and to provide overnight cover. Those were the only health board areas where specific proposals had been made by Hanly to close accident and emergency services at night and to concentrate services in regional centres of excellence. Recommendations in relation to other areas were to follow the local and European elections in June.
If the Government is to successfully challenge the anti-Hanly campaign organised by the Health Services Action Group, which includes opposition politicians and representatives of 16 local hospitals, it must display a greater focus and commitment to reform. Already, a sense of drift has developed where the three-pronged strategy of reform and restructuring - of which Hanly is one - is concerned. The Taoiseach has accepted that the working hours of "junior doctors" are unlikely to comply with EU law by next August. Vital negotiations on a common contract between consultants and Mr Martin are only at a preliminary stage. And a threat of hospital disruption still hangs over the issue of medical insurance for hospital consultants.
In such circumstances, it is difficult to blame local communities for seeking to hold on to what they have. A promise of better quality consultancy services at regional level carries little conviction when the situation in relation to existing A&E services in the major hospitals is described by the Irish Nurses Organisation as "a national emergency". For people in isolated communities, a journey of more than two hours to hospital is regarded as unacceptable. And yet, there is little investment in an ambulance service. Apart from financial investment, there is an urgent need to improve the quality of management within the health services. The greater Dublin region has been badly served in that regard. And the consequences arising from a reform of the Cavan/Monaghan hospital services provides a cautionary tale. The Minister for Health is correct when he says the Hanly report was designed to improve the quality of medical services on a regional basis, through the employment of teams of consultants and the injection of extra funding. That objective, however, should not exclude particular local needs.