Having spent much of the last 20 years at the healthcare coal face attempting to provide a decent service to patients, I hope today's much-anticipated health strategy document will lay the foundation for real reform of our beleaguered health service. What do I hope to see in today's document? The statistics are straightforward, showing the need for:
1,000 extra hospital consultants;
3,000 extra beds to reverse the steady decline since the 1980s. We must no longer prop up the European table of bed numbers per head of population;
1,400 extra rehabilitation and assessment beds to allow for the comprehensive care of the elderly;
7,000 additional day-centre places;
at least 200,000 more people to become eligible for medical cards; and
the transfer to appropriate accommodation of people with intellectual disabilities who reside in psychiatric facilities.
While making for an impressive list, these statistics will count for nought unless there is a fundamental change in the philosophy and structure of healthcare.
Today's strategy must commit the State's health service to the principle of equity. We must all know we have equal access to hospitals; this principle must be independent of our ability to pay, our socio-economic grouping, and where we live.
Central to the practical implementation of such a principle must be the creation of a single waiting list for hospital services. We must move rapidly towards the abolition of separate private and public lists, with their inherent and fundamentally unfair opportunity for those with the ability to pay to leapfrog those who cannot. It may be necessary to introduce a single waiting list for each speciality (rather than each specialist) in every hospital or health board. Whatever it takes, equity of access must be visible in the day-to-day working of the hospital system.
Moving beyond the hall door of the hospital system, the strategy must signal major reform in the way hospitals work. It is no longer good enough to bring a patient requiring surgery into a hospital bed two days before the operation. The preparation of a patient for planned surgery must be completed well before the date of the procedure. This will not only in- crease the throughput of patients, it will also minimise unfortunate last-minute cancellations which have become a feature of the present system.
Primary care and secondary care must interface far more effectively. It is simply not acceptable in an electronic age that general practitioners and hospital laboratories and appointment systems cannot maintain a "real-time" exchange of patient information. And there is also an urgent need for shared-care protocols between GPs and their hospital colleagues, which would reduce referrals and speed up the discharge of patients from out-patient departments.
If today's strategy fails to signal the rationalisation of health boards, then I will be concerned for its future success. While no one doubts the role of high-quality management, there must be real concern about the apparent duplication of management structures, which seems incompatible with our demographics. And is it not time to link administrators' pay and promotion to the on-time achievement of targets set by the Department of Health? Patients must be brought into the health service planning arena. Patient representative groups must be funded and encouraged; at local level, health boards must seek community feedback on quality of care.
People must also be offered a proper health information service of which e-health initiatives are a core part. "Telemedicine" - where specialists can provide consultations to a family doctor and his patients remotely - has much to offer communities along the western seaboard.
Accountability will be an essential element of a revamped service; some hospital consultants will be expected to change the way they work so that the "old chestnut" of allegedly giving priority to their private practice is laid to rest.
Financial accountability will be a key element. Regular performance review and a clearly visible audit cycle is the least the Ministry of Finance could expect for the massive expenditure associated with repairing the health system.
Accessibility, universality and public administration are the key planks that underpin a health service. They must be the fundamental drivers of today's strategy, so that our system treats a recent immigrant in the same way it treats a leading politician. Then and only then will we have a health service to be proud of.