The Taoiseach, Mr Ahern, entered the Cabinet meeting at Ballymascanlon, Co Louth, last week stating that the health service was excellent and well-resourced. Closeted with his colleagues he heard quite another story. The secretary-general of the Department of Health and Children, Mr Michael Kelly, and his officials, described the consequences of "endemic" under-investment in health: "serious deficiencies" in the hospital system with "long delays" and "unacceptably high bed occupancy levels" and a primary care system which was "patchy" and "overloaded". It is hard to imagine a starker contrast of views. The most senior men and women who administer the health service consider it neither excellent nor well-resourced. Not only do we have a poor health service but we have poor health relative to other European Union countries, they explained. The gap between life expectancy in Ireland and the EU is widening. After a lengthy and detailed presentation, much of which is reproduced in today's editions of this newspaper, the Cabinet then apparently declined the opportunity to question the officials further. The Minister for Finance, Mr McCreevy, left the meeting stating that he remained unhappy with how health allocations had been spent. Reading the presentation now, which he had just heard, it is hard not to conclude that the Cabinet had taken the time-honoured approach of "don't confuse me with the facts". While accepting that the service needs reform, the Department's presentation made clear that the Irish health service has been historically grossly under-funded compared to other developed States and that substantial extra investment is required to bring the service to the standard which the public demands.
It also made clear that what the Department administers is not just a health service but also virtually the entire social services of this State. The health spending allocations, which have failed to make a significant impact on hospital waiting lists, have been dispersed over a wide range of areas of social need: the homeless, children at risk, the intellectually and physically disabled and the elderly. What was at stake at Ballymascanlon was not just the future of hospital waiting lists and trolleys in corridors but whether Mr Justice Peter Kelly can find safe places to send abused and troubled children and staff to care for them; whether autistic children will have speech therapy in time to unlock them from their silence; whether community and, if necessary, residential, care will be available for the extra 1,500 people who will live to over 85 for each of the next ten years. The message of Ballymascanlon is all in the detail published today - a message that there are great and growing needs for social and health services in this State, which we have only just begun to meet. When will the Cabinet act on this message?
If the Taoiseach and the Minister for Finance had left Ballymascanlon accepting the case put by the Minister for Health, Mr Martin, and his officials, they could not go into the imminent election offering tax cuts to the electorate. In honesty, they would have to explain that if we want adequate healthcare and social services we must pay for them. They have yet to accept the unpalatable nature of that conclusion. They should heed, however, the reception which Mr Martin received later last week at the IMPACT trade union conference, when delegates accorded him two standing ovations, and informed him that if he had the courage to lead the health services as he proposed, he would win the approval of the vast majority of health workers and the population as a whole.