Analysis: In a bold move, the Minister for Health is set to take politics out of provision of a health service, but he must pace his reforms carefully, writes Dr Muiris Houston, Medical Correspondent
The structural changes suggested by the Prospectus consultants' review of the health service are the most far-reaching since the late Erskine Childers steered the 1970 Health Bill through the Oireachtas.
That Act brought about the introduction of the choice-of-doctor medical scheme in place of a dispensary service. Perhaps most significantly, it heralded the transfer of health-service administration from local authorities to newly constituted health boards.
Apart from the recent splitting of the old Eastern Health Board into three separate area health boards under the control of a new Eastern Regional Health Authority, this structure has remained unchanged for over 30 years.
Having disappointed many by failing to signal health-board reform when the National Health Strategy was published in November 2001, the Minister is about to remedy that omission.
In a bold move which will, at one stroke, significantly change both his Department and the institutions charged with service delivery in the regions, Micheál Martin has signalled the depoliticisation of healthcare in the Republic.
By creating a Health Service Executive, he will succeed in putting distance between the delivery of care and health policy development.
A slimmer Department of Health will cede much of its present responsibilities to the new executive.
At the same time, the politically driven health boards will be axed and replaced by four regional bodies that will have a much tighter executive focus than the 11 current structures.
In addition, they will be structured in a way that will allow for greater representation from health professionals and consumers.
The move must be seen in the context of an overall aim to reduce the number of health agencies in the State. Again the emphasis is on refining an obese and flabby system and producing one with a lean and fitter look.
There are two losers in the new health service scenario. One is the voluntary sector; hospitals such as the Mater and St Vincent's in Dublin, which have jealously guarded their direct relationship with the Department of Health.
But probably the biggest sector to lose out are the local councillors, for whom health board membership has been an opportunity to flex political muscle for the benefit of a local electorate.
Sometimes factional and often inward-looking, local politicians rarely took the opportunity to develop a strategic and long-term view of the health service.
It is this change that some will argue is also a major disadvantage of the new regional executive bodies.
Local representation is important if communities are not to feel alienated from State services.
It is therefore vital that local consumer representatives emerge to fully engage with the novel opportunity represented by the these reforms.
But being a "professional" citizen is not an easy task. Consumer panels must be well resourced and structured if the true voice of patients is to emerge.
Special care must also be taken of those on the margins; people with psychiatric illness, those with disabilities and family carers can find it difficult to contribute unless they are specifically enabled.
It is important to get the rate of change from the old to the new system right. Too quick and people feel threatened. Too slow and there is a risk of inertia as the old system stagnates.
Although it may be difficult to imagine the public health service being any worse than it is at present there is a real danger of further deterioration and staff disillusionment if legislation to bring about these changes is delayed.
Overall, the advantages of the proposed changes far outweigh the disadvantages.
Greater accountability is built into the new structures; no longer will each mini-crisis presage a "ping-pong" reaction of blame and counter-blame between the Department and a health board.
It will make implementing change easier; the slimmed-down executive structures should produce a leaner acute hospital sector.
And with uniform information technology running through the system, the abject failure of the current system to identify what exactly it is doing and how it is spending public money should end.
The all-too-obvious deficiencies in our health service are an indictment of the political process. Structures which emerged from county councils were always going to favour local over national imperatives.
With the Prospectus review comes a real opportunity to move with the times.
Micheal Martin faces some tough encounters in the weeks and months ahead.