Difficulties besetting the health service are likely to worsen in the coming year, in spite of reassuring promises made by the Government. The annual conference of the Irish Nurses Organisation (INO) has insisted that its members will embark on industrial action next October if the current benchmarking process does not grant them a 30 per cent pay increase.
In the present economic climate, with tax revenues shrinking rapidly and the increase in Government spending running at 21 per cent, such a pay settlement is unlikely. In addition, the INO has stated its members will not co-operate with the commissioning of extra beds unless a sufficient number of nurses are in place. And, given the recent decision by the British government to spend a great deal of extra money on its health services, a further leakage of Irish nurses can be expected.
Some 1,500 Irish nurses left the health services in the past 18 months and the slight increase in overall numbers here has been achieved by employing nurses from outside of the European Union.
There is broad agreement between the political parties that reform, restructuring and investment is urgently required if an effective health system, giving value for money, is to be developed. But the Government and opposition parties disagree fundamentally on the nature of that service. Fianna Fáil and the Progressive Democrats have decided to retain an overlapping private and public health service, with its inherent inequalities, while advocating reform and higher spending. Fine Gael and the Labour Party, on the other hand, favour the introduction of a universal health insurance system, such as exists in Belgium, while promising further investment in capacity and infrastructure.
At the moment, some 42 per cent of the population is covered by private medical insurance and the figure is rising. It is an expensive investment . But it is undertaken in the sure knowledge that it confers a licence to jump the health queues. The Minister for Health, Mr Martin, said this week that people will be allowed onto a formal hospital waiting list in future, if they have been waiting for three months. But he declined to endorse the campaign pledge made by the Taoiseach, Mr Ahern, to end all hospital waiting lists within two years. Mr Martin said he would not regard it as a resigning matter if that particular promise was not kept.
The politicisation of health services; the retention of small, inadequate hospitals and an excess of health boards were criticised yesterday by the Dean of Medicine at UCD, Mr Muiris Fitzgerald. At the same time, the Secretary General of the Department of Health, Mr Michael Kelly, spoke of the need to abolish traditional lines of demarcation between the various medical disciplines. At this stage, the choice before the electorate is not one of reform, which is inevitable. What is at issue is the foundation on which that reform will take place.