Harney's Broken Promises

Mary Harney chose to take on the Department of Health in October 2004 believing that only she could reform the Irish health services. Three and a half years on, all of her main promises on health are broken.

By Sara Burke

1. Promise:
More hospital beds
One of the key commitments in the 2001 health strategy ‘Quality and Fairness' was the introduction of 3,000 new public hospital beds. Six years on, less than 1,000 new inpatient beds have been added into public hospitals.  Mary Harney's co-location plan – to build for profit private hospitals in the grounds of public hospitals – promises an additional 1,000 beds, yet not one sod has been turned on any of these hospital sites.
To expect these new beds to in place by 2011 – ten years after the health strategy – is ambitious, and still 1,000 beds short of the 2001 promise.

2. Promise:
Hundreds of primary care teams
The primary care strategy was published the same week as the health strategy. It promised to reorient healthcare towards prevention and community care with the development of hundreds of primary care teams. Ten pilot teams were funded. And then for years nothing happened.
Since 2006, there has been renewed emphasis on primary care, albeit a diluted version of what was originally planned, while the intended infrastructure has never materialised.
Commitments made in the 2007 Programme for Government promised that 300 teams would be in place by the end of 2008. Yet the HSE 2008 Service Plan promises just 187 teams by the end of 2008, 123 short of the Government's commitment less than a year ago.
Even Mary Harney has criticised the HSE for its failure to meet her commitments for 2008, saying it falls short of “what reasonably could be expected”.

3. Promise:
Reform cancer care
Mary Harney consistently promises to deliver better cancer care. Of particular importance to her is breast cancer. Breastcheck, the screening of women aged 50 to 64 years, is still not available to women in large parts of the South West and North West, despite promises that it would be in place countrywide by 2005.
In the recent Portlaoise cancer crisis, Mary Harney stated publicly that until the eight specialist cancer centres are operational, she cannot guarantee that what happened in Portlaoise – the misdiagnosis of eight women – will not reoccur elsewhere in Ireland. There is no definite date for the centres to be fully functioning.

4. Promise:
A new consultants contract
Reaching agreement on a new consultants contract has been one of Mary Harney's flagship projects. Yet, negotiations are still ongoing. Although in principle, a deal has been done between the HSE and the consultants, there is still no final contract between the two sides; consultants have yet to see a hard copy of the deal.
Crucially, no new consultants have been appointed while the protracted negotiations continue.

5. Promise:
A reformed health service
The Health Service Executive (HSE) was established on 1 January 2005, to bring about a unified, accountable health service that devolved power locally.
Three years on, there is still confusion as to who is responsible for what, alongside complaints from politicians, unions and patient organisations that it is more centralised, bureaucratic, top heavy and unaccountable than ever before.
The Fitzgerald Report into the HSE's management of the Portlaoise cancer crisis, found that  “there was a fundamental weakness in the management and governance of this process from the outset… there were too many people involved from different levels and areas within the HSE, without clarity about roles and responsibilities… the decision making process was fragmented, with insufficient clarity about decisions, who was making them, why they were being made, or when they were signed off”.

6. Promise:
Safe and equitable nursing home care
The 2001 Health Strategy promised 5,600 extended care/community nursing places over seven years. Seven years later fewer than 500 new public nursing homes beds are in place, although thousands of new private beds have been contracted.
When the abuse of older people in Leas Cross – a private nursing home – was exposed in May 2005, Mary Harney promised that all nursing homes would be independently inspected. Yet, not one nursing home in Ireland is independently inspected.
Currently private nursing homes are inspected by the HSE (which also contracts these beds), while no one inspects public homes run by the HSE. Mary Harney promised the ‘Fair Deal', a new funding mechanism for nursing home care, to be in place by January 2008. It is not yet in place and there is no date for its introduction.

7. Promise:
Implement a new mental health strategy  
A new mental health strategy ‘A Vision for Change' was launched in January 2005 with the political promise of €25 million per annum to implement it.
In 2006 and 2007, just over half of the promised €50 million was invested, while in 2008, no new money has been allocated to implement the strategy.

8. Promise:
Ensure equity of access
The health strategy ‘Quality and Fairness' had equity (“people treated fairly, according to need”) as one of its core principles. The 2002 and 2007 Programmes for Government also promised equity of access. Yet in 2008, public patients still wait longer for diagnosis and treatment than private patients.
While this has been the case for decades,
Susie Long brought this issue to public and political attention. Susie Long was a public patient who had to wait seven months for a colonoscopy before being diagnosed with stomach cancer. As a result she started her cancer treatment seven months later than if she had been a private patient. This resulted in her premature death.
When Susie Long died in October 2007, Mary Harney assured the nation that lessons would be learnt. Yet recent figures show that in some hospitals public patients wait up to 18 months for a colonoscopy while private patients wait just days for such a procedure.

9. Promise:
Improve conditions in A&E
Since becoming Minister for Health, Mary Harney has prioritised improving conditions in A&E. In November 2004, she announced a ten-point plan to solve the crisis. In January 2005, she said: “I expect real and measurable improvements in the coming months, A&E is a litmus test for me.” In March 2006, she declared A&E a national emergency. In April 2006, the HSE set up a Task Force, whose report was published in June 2007 six months after its completion. The Task Force recommended a target of six hours or less wait time in A&E by 1 January 2007. This target has still not been set.
According to the HSE, on 18 March 2008, 131 patients were awaiting to be admitted to hospital in A&E. Of these, 71 per cent were waiting over six hours. The Irish Nurses' Organisation counted 273 people waiting on trolleys on the same day.
Consultants in A&E issued a statement saying that conditions and waiting times in A&E are as bad as ever, with seven departments “unfit for purpose”.
“There is still a culture of acceptance of trolley waits which extends right up to the Minister for Health and Children who stated in the Dáil that waiting on a trolley could be ‘a pleasant experience',” the statement said.

10. Promise:
400,000 more medical cards
In 2004, Mary Harney promised that an additional 200,000 people would receive full medical cards and that 200,000 people would be covered by the new GP only cards.
According to the Department of Health on 1 February 2008, an additional 135,427 people had medical cards (64,573 short of her commitment), while 76,094 people had GP
only cards (123,906 short of her commitment).