After unprecedented analysis of its modus operandi, the health service has begun the New Year amid grave doubts over the implementation of the sweeping reforms proposed to provide patients with better care.
On foot of its analysis, Prospectus stated the need for structural reform, with a clear division between a policy-making Department of Health and a Health Service Executive responsible for service delivery. The Brennan commission looked at accountability and recommended tighter controls to link financial input to service delivery. And David Hanly's taskforce on medical manpower addressed the issue of an EU mandatory reduction in junior hospital doctors' working hours by next August. Its solution involved a major restructuring of acute hospital services and triggered hostile political reaction and community campaigns aimed at "saving" local hospitals.
So whither hospital reform in 2004? An interim health service executive has just been appointed. Significantly, its membership includes three people who sat on the Brennan Commission and one member of the Prospectus review group. The absence of a representative from Hanly suggests a political decision to give primacy to those who would champion internal restructuring and value for money initiatives rather than radical reform.
Such emphasis would also reflect the realpolitik of the Exchequer funding provided for health spending this year. With no additional resources to provide for significant reform - apart from the 100 per cent increase in support for much-needed information technology - a major restructuring of the health service cannot proceed.
The only specific reference to reform by the Minister for Health, Mr Martin, in his estimates statement was vague and hardly constituted the language of a Minister confident of full-blooded change. Annual funding for health has broken the €10 billion mark but Mr Martin needs the bulk of this to maintain the status quo. An additional €2 billion is probably required to bring about significant change.
It is a great pity that having identified what is needed, the funding is not being made available to deliver radical reform. With no tangible progress, those working in the health service will lose faith and, more importantly, those using the service will pay the price.
Since the publication of the Prospectus, Hanly and Brennan reports, there has been a conspicuous silence from some professional organisations. But it is not enough for royal colleges and others to drive reform from behind; it is incumbent on all stakeholders to adopt the role of interested participants rather than vested interests to achieve the best outcome for the patients who use the services they provide.
2004 will be a year of health service rationalisation rather than reform. At best it will deliver welcome efficiencies. But real improvement will only come about when political drive is combined with a level of ongoing funding designed to bring about lasting change.