A decision by the trade union, IMPACT, to withhold co-operation from the health reform programme, because of a lack of consultation and consistency by the interim health service executive, is just the latest manifestation of a deep malaise affecting the entire system.
The Tánaiste and Minister for Health and Children, Ms Harney, must now take urgent and difficult decisions to drive the reform programme forward following the withdrawal of Professor Aidan Halligan as chief executive officer designate of the proposed executive.
Blame for the current, appalling mess cannot be laid exclusively at Ms Harney's door. After all, she has had direct responsibility in this area for only a couple of months. But, as a member of Cabinet with collective responsibility, she and her colleagues must share the blame for the manner in which reform of the health services has been handled. There has been a lack of consultation and certainty at all levels over the past year as new structures and systems affecting up to 150,000 employees have been mooted.
In calling for a Dáil debate, the Labour Party spokesperson on health, Ms Liz McManus, was particularly scathing of the fact that legislation giving effect to the entire health reform programme has not been published yet, even though the relevant bodies are due to become operational on January 1st. That is no way to run a health service. The delays and overlaps being created through political and administrative bungling have the capacity to add to, rather than subtract from, existing layers of bureaucracy. Such an outcome would be disastrous.
There is absolute unanimity in political and medical circles about the need for reform and for the establishment of efficient managerial structures. After that, consensus breaks down as powerful vested interests fight their respective corners. The quality of decision-making, funding and management, from Departmental levels down, attracts consistent complaints. In the same way, accountability at local level is not enforced. And old, inefficient relationships and work-practices persist.
The Government has promised the most far-reaching reforms. But, on the evidence of what has been achieved so far, the public should retain a healthy scepticism. In seven years, spending on hospitals alone has risen by €2.2billion and 3,500 extra staff have been employed. Of these, only 400 are nurses. Fewer than 600 extra beds have been provided.
Ms Harney deliberately chose to make her political mark in the area of health. She must now get a grip and drive the reform programme forward.