This has been another difficult year for the health service. But the Budget signalled a new emphasis on primary care and on care of the elderly in the community, which may produce tangible benefits for patients towards the end of 2006. However laudable it is though to recruit 300 additional front-line staff to develop primary care teams, and to spend €110 million next year on extra supports to enable older people to live independently, the challenge for the Health Service Executive (HSE) will be to deliver these services on the ground where there is a shortage of nurses and therapists.
A review of the 10-point plan for the accident and emergency crisis, announced in 2004, illustrates how difficult it can be to bring about change. More than 400 long-stay patients have been discharged and sent home from Dublin hospitals under the plan, but promised medical assessment units in Tallaght, St Vincent's and Beaumont hospitals have been slow to materialise.
The need for a single administrative structure for the health service was clearly demonstrated this year by the PPARs debacle. Now that the HSE and its chief executive, Prof Brendan Drumm, have had time to "bed down", the public is entitled to expect a more rapid and efficient implementation of Government health policy. Prof Drumm's vision of a patient-centred health system must be translated into front-line action.
The inquest into the death of Frances Sheridan at Cavan General Hospital some three weeks after her appendix was removed highlighted questionable practices: the hospital was unable to find her medical notes when she returned; and there was no direct supervision of a junior doctor by a hospital consultant. New HSE guidelines on the admission and discharging of patients should help. But such lapses are worrying.
Nor is it acceptable that a survey of the hospital experiences of 5,000 patients found that almost half were not advised about possible side-effects from medication while one-in-four had unanswered questions concerning their treatment. New patient care groups, promised by Prof Drumm, should have adequate patient representation and must be established early in 2006. On top of that, the Republic has one of the highest rates of MRSA infection in Europe, and the control of hospital-acquired infection will continue to be a major challenge next year.
Priorities for 2006 within the National Cancer Strategy must include a national cervical cancer screening programme as well as beginning the roll-out of a national network for radiation oncology services.
At a policy level, the Minister for Health should ensure that rises in taxation on cigarettes and alcohol are not blocked by fears of the impact on inflation. And it would be helpful if the Minister issued a policy paper outlining how the expanding private health sector will integrate with the existing health system in 2006 and beyond.