OPINION/Padraig O'MorainYou don't often get drama in newspaper editorials, but yesterday's Irish Times provided the exception. There, in the middle of a piece about the threatened cutbacks in hospital services, the leader-writer opined that the brake applied to health spending by the Minister for Finance last December "was always likely to produce a situation akin to switching off the engine of an aircraft in mid-flight".
While it would be tasteless to carry this analogy too far, the week has certainly brought us to the realisation that the heady years of promise and expansion have ended with a mighty bump. Actually, the public was never that impressed by those heady years. Policy-makers in the health service became caught up in producing a national health strategy sought, apparently, by the Taoiseach, but the public did not care.
The public was fed up with spending hours and sometimes days in Accident & Emergency while waiting for admission to a hospital ward. It was fed up with waiting lists. It was fed up with the poor level of subsidy towards the cost of prescribed drugs for people not on the medical card. It was fed up with the frightening cost of nursing home care.
The national health strategy was duly launched not once but three times. Today, I doubt if there is anybody out there - apart from a few sad souls like health journalists, who are paid to know these things - who could name a single course of action recommended by the strategy.
So the wreckage of the strategy is strewn, to finish with the aircraft analogy, over a wide area of mountain and desert, and nobody has bothered to go looking for it.
Now the reports come thick and fast of the cancellation of hospital services. Things may not be quite as awful as the hospitals are making out - an air of crisis is always a help when negotiating for funding - but things are, nevertheless, bad.
Even the Eastern Regional Health Authority has warned that this will be a "difficult" year for acute hospitals and that it will be seeking to "ensure that areas of priority care are maintained" in Dublin, Kildare and Wicklow. That's a significant statement - it is unusual to find official bodies such as the ERHA admitting that things might be difficult or that services might need to be prioritised.
Such admissions are not liked very much in the Department of Health and Children - when the Western Health Board made it clear last year that it would have to introduce cutbacks, it was summoned to the Department to explain itself. This is the time of year when Ministers for Finance set their faces sternly against any further funding for health services. And Mr Charles McCreevy, as we know, believes that the health service has the capacity to soak up enormous sums of money without delivering improvements.
That attitude ignores the fact that hospitals have a proven record of increasing their output. Shorter length of stay in beds and more day surgery means that hospitals are doing far more now than they were 10 years ago.
And there are instances of hospitals using new money in creative and effective ways. A recent report in the Irish Medical News, for instance, revealed that St Luke's Hospital in Kilkenny has not had beds in corridors for more than a year - a problem which had dogged it for more than two decades.
Close co-operation between GPs such as Dr Richard Brennan, who is also chairman of the Irish College of General Practitioners, and hospital staff such as consultant physician Dr Garry Courtney, has brought about a situation in which patients referred to the hospital by their family doctor can avoid the A&E department altogether, get quick, specialist treatment in a medical assessment unit and be home far more quickly than if they were in the old beds-in-corridors purgatory.
This was all done through a combination of Mr McCreevy's money and a bit of savvy thinking and co-operation between the hospital, local doctors and the health board. So don't buy the notion that the health system eats up money and gives nothing in return. It's just not true.
Mr McCreevy does, however, have a genuine problem. In this country we like low rates of income tax. If Mr McCreevy was to lose the run of himself and to announce, say, a 10 per cent health tax to be shared equally by employers and employees, he would be strung from a lamp-post in Merrion Square.
Nevertheless he, the Taoiseach and the Minister for Health and Children gave a commitment before the general election that the development of the health services would continue even if money had to be taken from other areas of the economy. Well, that was a fairytale, and we were worse fools for believing it.
Hpwever, there are some initiatives we should expect, even demand, regardless of the economic gloom. One is that the medical card be extended, urgently, to families on low pay. That this was not done was one of the great failures of the previous government. GPs talk of children brought to them with advanced conditions because their parents could not afford to bring them to a doctor as often as they ought to have done. They also talk of parents sacrificing their own health for the sake of being able to afford doctors' bills.
Earlier GP treatment, by the way, means thast these parents and their children will be less likely to need hospital care than at present. There is also a strong case for directing the National Treatment Purchase Fund, which buys private treatment for public patients who have been more than a year on the waiting list, to purchase as much treatment as possible from public hospitals. These and other measures can and should be taken without breaking the bank.
The health system is more resilient than it is given credit for. It deserves better than to be starved of money which would enable it to do sensible and necessary things.
Padraig O'Morain is a health and social affairs journalist