Between the 11th and the 22nd of September, when voters were asked by the MRBI pollsters to identify the major issues on which the next election campaign should be fought, health came high on the list with almost a quarter of those polled putting it top of their agenda. The word "health", of course, could cover many issues - from health protection to disease prevention - but it is not unreasonable to suppose that most respondents were thinking of the health services and the shortages of staff and facilities, the growing waiting lists for hospital treatments and the non-availability of particular services in some areas of the country. Almost two thirds of the people interviewed put health in their top three among the issues which they wanted to hear about from those contesting the next election.
It is almost inconceivable that this might have been the case a mere thirty years ago when this State had one of the better health care services in the world. Clinical standards were high and services were generally available without significant waiting lists for those in need of them. Morale and commitment were also high among most professional staff and most patients spoke positively about the quality of care they received in Irish hospitals. The costs of care were not unreasonable, either for the Exchequer or for those patients who opted to use the relatively subsidised private wards in public hospitals, yet national expenditures on health care were at or about the European norm. Ireland was better off in terms of comprehensive and inclusive health care for its citizens - regardless of their individual financial situations - than was the United States of America, and the health statistics bore out that fact.
Yet there were indications which might have pointed to the problems which lay ahead. Budgeting and cost controls were quite primitive within what was becoming a more sophisticated hospital service and the rapid move to costly new high-technology surgical and medical procedures was starting in earnest. The gulf between hospital and community care was already wide and there was no significant infrastructure to bridge that gap. The hospitals were apart from the community-care services rather than a part of them and not even the most dedicated of administrators had the training to be able to challenge the power of the hospital consultants.
Those are some of the reasons why it will prove instructive to read carefully the series of articles which start today in this newspaper to examine how a pretty good health service deteriorated to the point where most electors think it a priority that health be a significant component of the next election campaign. National expenditure on health care here is now less than in most other European countries. Staff numbers have declined below critical levels and morale is low among those who remain. Health-care structures and systems need some radical changes if the service is to be restored to its former effectiveness. The political parties will be wise to prepare some persuasive proposals for change before they go before the electorate this time around. The voters will have some serious questions which will need to be answered satisfactorily by the parties and their candidates for political office.