Mary Harney's dismal

Promises unfulfilled, expectations unrealised, the computer debacle merely masks the other failures. By Mary Minihan

It's unlikely that the Progressive Democrats were planning to celebrate Mary Harney's first anniversary in the Department of Health and Children, but if they were, the PPARS computer payroll system debacle put paid to that.

Twelve months ago, even Labour leader Pat Rabbitte acknowledged that taking on the 'Angola' posting in the first place was a brave move. "Frankly I do not know how to read it," he uncharacteristically admitted.

Rabbitte clearly thinks he can read Harney now.

His portrayal of the Minister's photogenic predecessor, Micheál Martin, as a "male model" in the Dáil last week was wickedly funny. ("Micheál does preen," one senior Fianna Fáil figure later admitted privately.) But Rabbitte somehow came across as plain old grumpy when he attacked what he called Harney's "folksy, down-home, everybody-trusts-me" style of doing business.

To date, public dissatisfaction with the state of the health services does not seem to have focused on Harney herself. Her personal rating in opinion polls has not dropped. A Teflon Tanaiste?

Mary Harney set out her own priorities a number of times. When she first addressed the Dáil as Minister for Health on September 29 last year, Harney delivered a pre-emptive strike against anticipated criticism that her tenure would be driven by "ideology. She followed this with some general introductory comments on how she intended to carry out her new role, such as: "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."

She gave her first major interview since becoming Health Minister to RTE at the start of October 2004, prioritising the provision of care facilities for the elderly, as well as pledging improvements in A&E and cancer services.

Back in the Dáil on October 12 last year she outlined four aims; to improve A&E units, because it was "unacceptable that people have to spend upwards of 12 hours on a trolley before they are admitted to a bed in an acute hospital"; to reduce waiting lists; to extend the income threshold for medical cards, "which we all accept is too low"; and to prioritise oncology services. The 2002 programme for government had promised the "development of a world-class public health service is a core objective for us". That promise can now be set aside the reality that (according to Irish doctors) Polish and other immigrants continue to travel home for medical treatment. A&E consultant Tony Martin of University College Hospital Galway, (also president of the Irish Association of Emergency Medicine) says Harney has been the victim of bad advice. "I think she's a very good person. She sets out to do things, she doesn't set out to stop things, but..."

The "but" is the fact that, after Harney's first year in the Department, the number of people staying overnight in hospitals without a bed is now greater than it was this time last year. And what used to be a winter problem is now a year-round issue.

The Irish Nurses Association claims 166 patients were on trolleys in A&E departments on November 1 last year. On September 27 of this year there were 243. Tony Martin agrees: "Things haven't got better. It's a fact. We're just backing up, backing up, backing up because we're never catching up."

He claims there is no real interaction between the Department and A&E. "We are told what we should be doing, we are not being asked. When we say anything we're accused of acting in our own interest."

On the medical cards promise, the promised 200,000 GP-only medical cards may be about to transpire after a recent resolution between the Irish Medical Organisation and the Minister. But the 30,000 'full' cards also promised last November have not materialised, despite the setting aside of a €30 million budget.

Dr Martin Daly, chairman of the IMO's national GP committee, says: "Since 1997 over 200,000 people have lost their entitlement to a full medical card. Under new proposals, they are being offered back their medical cards with diminished entitlements," he says.

"A person exceeding half the hourly minimum wage will lose the medical card.

"It seems incredible that people on such low incomes, in such a wealthy country, cannot access the most basic type of health care."

He is critical of the Minister's practice of pointing to rising incomes and increased prosperity, because "these people are not part of that tide".

On the commitment to the elderly, Age Action Ireland spokesman Paul Murray says: "Mary Harney seems to think the answer is private nursing home care. But we need a good strong public sector. When you look at the 'sophisticated' Scandinavian countries, they have good public care. Private care is becoming a substitute for public care when it should be an adjunct." He points out that large English nursing homes are moving into Ireland for "easy pickings" because they see the State is not providing public care for the elderly.

"The trouble with PD economics, the kind of philosophy of the current Government, is that issues of rights are not very high on the agenda. The economy is getting in the way of social thinking."

Criticism has also been made of Mary Harney's failure to produce a Bill to to establish an independent Nursing Home Inspectorate and legislation to repay illegal nursing home charges.

There are also criticisms of her record on the waiting lists commitment. Some progress appears to have been made through the National Treatment Purchase Fund, according to Irishhealth.com editor Niall Hunter.

He says the patient treatment register introduced in July is "certainly a more sensible system for calculating lists and trying to give people access to treatment where possible, but the waiting lists are still very much there".

While the numbers appear to have been reduced in Dublin, figures for hospitals outside the capital have yet to be published.

The editor of The Irish Medical Times, Colin Kerr, says medical professionals and their patients are tired of being told to wait for reforms to bed down.

"You might argue that Mary Harney has been in office only a year but it should be remembered that she has been a member of Government for the last eight years. She should have been aware of the issues coming into the office. People are really not prepared to wait around any longer. Unless she tackles some of the really big issues, like the promised Medical Practicioners Bill and GP manpower, I don't think she can actually be judged to have been a success."

Village submitted questions to the Department of Health, but had not had a response by time of press.p