Some tough obstacles remain on the way to a reformed health service, writes Dr Muiris Houston, Medical Correspondent
In publishing the deliberations of the National Task Force on Medical Staffing, (the Hanly report), the Minister for Health has completed the package of reforms with which he proposes to revamp our beleaguered public health service.
Between them, the Hanly, Brennan and Prospectus reports, set out the need for the reorganisation of both medical staffing and hospital services. What is now needed is the financial wherewithal and the political will to see the process through to completion.
Hanly itself contains few surprises. Well leaked at various stages of its drafting, the sting contained in earlier drafts has largely disappeared.
The location of 12 major hospitals dealing with acute admissions and trauma is no longer spelt out. Instead we have the principles for reorganisation of acute hospital services.
However, a little lateral thinking and it becomes obvious which hospitals will be developed as part of the health service reform programme.
In each of the two regions studied in detail by the Hanly Task Force - the Mid-Western Health Board and the East Coast Area Health Board of the Eastern Regional Health Authority - a major hospital emerges. Limerick Regional Hospital and St Vincent's University Hospital are the obvious locations to provide a full range of 24-hour emergency and trauma services in each region.
In the Mid-West, this means major changes ahead for Nenagh, Ennis and St John's, Limerick, hospitals. On the east coast, Loughlinstown and St Michael's are set to become "local hospitals", which will provide the majority of hospital care, including outpatients and diagnostic services, to the local population.
The Minister warned yesterday against labelling this process as a "downgrading" of hospitals.
"Instead, we need to bring services closer to patients while ensuring that those services are both safe and sustainable," he said. Whether local communities see the loss of an accident and emergency service in this light remains to be seen. But Mr Martin says accident and emergency is a key part of any reform.
"The evidence is clear. Patients do better in hospitals that have the required numbers of specialist staff, high volumes of activity and access to appropriate diagnostic and treatment facilities."
The trade-off is that people will be able to access a wider range of high quality care in the smaller hospitals. In practice, this means that your hernia operation or gall bladder removal will take place in Loughlinstown or St Michael's and not St Vincent's, if you live in the south-east of Dublin.
If you have had your baby delivered in Holles Street, the follow-up outpatient visit will be in the local hospital also. Only for the most hi-tech diagnostic investigations will you attend St Vincent's.
The main driving force behind Hanly was the need to meet the requirements of the European Working Task Directive. This states that by August 1st, 2004, junior hospital doctors must no longer work for more than 58 hours per week on a hospital site.
Rather than increase the numbers, Hanly was instructed to plan for additional consultant numbers, thereby moving to a consultant-provided, rather than consultant-led, health service.
This significant change would also allow a reform of the current system of medical education and training. Implementation of Hanly must therefore proceed on three fronts. The Minister has signalled that he wants immediate movement on all three. The Labour Relations Commission has been asked to convene a meeting between employers and the Irish Medical Organisation.
A new contract for hospital consultants is to be the subject of an early meeting between the Health Service Employers Agency and the doctors representative organisations. And the Task Force recommendations in the two pilot areas are to be implemented by project groups in each.
To his credit, Mr Martin has come straight out of the blocks on this one. Following a somewhat slow reaction to Brennan and Prospectus, he presumably realises that the chips are down; there are no more reports waiting to be published. It's implementation or nothing.
But before we get too carried away with the potential pace of reform, there are a number of obstacles. Will Mr McCreevy provide the finances to make such expensive reform happen? How will politicians in the mid-west and south-east Dublin react?
And will the medical organisations facilitate the fast conclusion of new contract negotiations which Mr Martin says he wants?
The experts have spoken. The pathway to major reform has been mapped out. Two ingredients remain - financial resources and the political will to change.