Mary Harney: Little left to lose

The acting PD leader has failed by every measure of the government's own health strategy
By Sara Burke

“I do not take my politics from any ideology; I am not an ideologue… The one thing I want for the country I love is to have a health service that is accessible to every citizen, regardless of their wealth”, said Mary Harney upon her appointment as Minister for Health on 29 September 2004. But now, as a minister without a party (the PDs are gone), ambition or political future (she is not to stand in the next election), she may have little left to lose.

Her stewardship of the health service is widely regarded as a disaster, with recurrent controversies (see following stories). She was instrumental in the establishment of the HSE. She fought with the Department of Finance to give the HSE complete control over its huge budget. She felt the health system needed rationalising, so the eleven health boards and a clutch of other health agencies were amalgamated.

Instead of a voluntary redundancy scheme, managers in the all the boards and agencies were lured with promotion. Not one person lost their job in the ‘rationalising' process. The HSE was heralded as bringing about greater accountability and integration of services. And although its early days for any organisation that has undergone such huge change, the Portlaoise controversy does nothing to demonstrate increased accountability in the health service.
In her first speech as Minister for Health in September 2004, Mary Harney talked about all the work which went in to the preparation of the 2001 health strategy, ‘Quality and Fairness', and how she intended to implement it.

Six years after its publication and three full years after Mary Harney became Minister, the core components of the health strategy (quality and fairness) have not been acted on. Patients can hardly feel safe, given what happened of late at Portlaoise, the MRSA scandal and conditions in A&E.

The promise that patients would be treated on the basis of need, not on the ability to pay, manifestly has not happened and the two-tier system continues to flourish, indeed with her encouragement.

Outcomes are poorer for those who have to wait longer for what can be life saving health care, evident in the early and unnecessary death of Susie Long. Private patients are privileged over public patients, evident in the different waiting times to see a consultant.

The health strategy also promised 2,800 more public hospital inpatient beds, of which less than a third have been delivered. The 1,000 beds which will be freed up as a result of the co-location plan are at least four years off,  that will be ten years after the publication of the strategy.

An examination of changes introduced since 2001, or since she became Minister for Health in October 2004, shows no evidence of any action to promote fairer access for public patients in the past three or six years. Instead, there has been an increased emphasis on private health care, most evident in the plan announced in June 2005 to co-locate private hospitals on the grounds of public hospitals.  

But more fundamentally, she makes no acknowledgement that the major public health issue of our time is that poor people get sick more often and die younger. Most of the causes of poor health lie outside of the health system. It is one's income, educational opportunities, housing, environment and life chances that determines one's health.
While governments across Europe have ministerial task forces and cross-departmental groups driven by the Department of Health to tackle health inequalities, it is not even on the agenda in Irish health policy.