The Coalition Government has unveiled the first elements of a major programme of restructuring and reform within the health services, designed to give better value for money, reduce bureaucracy and provide greater consistency in the provision of hospital and community care.
No indication was provided of the savings that might result from these changes and no commitment was made to provide extra funding for our hospitals. In spite of such defects, the Minister for Health, Mr Martin, should be encouraged in his endeavours to introduce overdue managerial reforms and to secure better value for money in a system where Government spending increased from € 3.6 to 9 billion during the past six years.
The need for structural reform has been evident for years. But the level of commitment to innovation at this time would suggest a changing of the political goalposts by the Coalition Government from health spending to health structures. The vulnerability of the Government on health issues - 95 per cent of voters take the view that it has broken its pre-election promises on hospital and health care - was reflected in the attendance by the Taoiseach, Mr Ahern, the Tánaiste, Ms Harney, the Minister for Finance, Mr McCreevy, and the Minister for Health, Mr Martin at yesterday's press conference. All talked about better and more efficient services, but they clearly expected those to be provided from existing levels of funding. The Tánaiste specifically ruled out raising money for the health system through higher taxes.
Under the proposed reforms, a new Health Service Executive is to take over from existing health boards and the Eastern Regional Health Authority. The structure will shift day-to-day control away from the Government and local politicians. The abolition of health boards is likely to generate some political resistance. But Oireachtas members will be relieved that the ending of their dual mandate will not allow competing councillors acquire positions on health boards. Provision has been made for Oireachtas members to make twice-yearly representations on health issues at Executive level.
Legislation to give effect to these changes will be prepared during the next two years. In the meantime, the Health Service Executive, a National Hospitals Office and other elements will be established on an interim basis. If the public expected the process of restructuring and reform to cut administrative fat from the health services, it will be disappointed. Much was made of reducing the number of health agencies from 58 to 27 in the report. But only two have actually been abolished. And there will be no redundancies.
The missing piece from yesterday's reform package is the Hanly report on the acute hospital system and the role of consultants. On the basis of comments by ministers, however, our two-tier health system, which discriminates against the poorest section of society, is likely to remain firmly in place. Reform of the structures does not automatically guarantee a better service to patients.