What's the Mater, Mary?: ThePost.ie


TCH Archives > Sunday Business Post > 2004/10/24 > What's the Mater, Mary?

What's the Mater, Mary?
Sunday, October 24, 2004

By Sean Mac Carthaigh
Poor Mary Harney. Who could have anticipated that the health service would be such a shambles?That there would be long waiting lists and patients on trolleys?

Who would have predicted that there might be some bad publicity attached to being the government minister with responsibility for these nightly reenactments of the Battle of the Somme in accident and emergency (A&E) wards around the country?

Well, Mary Harney could have, and did.

The notion that Harney somehow stumbled blindly into her new job, and is content simply to inherit the government's "health strategy'', is somewhat naive.

Harney is an old political pro, and can see the tank traps more clearly than most. She took the job because she was convinced she could turn it into a political asset, and do so in time for the next general election.

And could it be that Bertie Ahern, every bit as devious a power-broker, gave it to her because he knows that election might be sooner than she imagines?

Harney has come under sustained pressure all week, mainly over the accident and emergency wards.

Monday began with Dublin Sinn Féin councillor Christy Burke, an old hand at setting political snares for rival parties, demanding that Harney go to the Mater Hospital's A&E ward "to see for herself the unacceptable situation'' of injured and bleeding Dubliners forced to wait for days for a bed space.

It was a win-win: either she would go to the Mater and be photographed amidst the chaos, or she wouldn't - and could be characterised as being out of touch.

Labour Party's health spokeswoman, Liz McManus, immediately declared that Harney had lost control of the situation, and demanded that Bertie Ahern should assume direct charge of introducing measures to stem the crisis.

She further turned up the heat on the relationship between the Taoiseach and Tánaiste, saying: "The new Minister for Health, Mary Harney, has plenty of sympathy but no ideas.

"In these circumstances, the Taoiseach himself should take charge of the situation, particularly as the Mater is in his own Dáil constituency," she said.

The following day in the Dáil, McManus raised the matter on the adjournment.

The problem Harney faced was now worse than ever - and that was before the onset of winter.

"Is she not afraid of what impact a flu epidemic could have on an already pressurised service?

"In this city today, there were 164 patients waiting on trolleys in our accident and emergency departments.

"Yet hospital wards are closed, new facilities unopened, and over 300 beds inappropriately occupied," said McManus.

She put Harney under further pressure with some hard data, arguing that the kernel of the problem in the Mater and elsewhere was the lack of beds.

"In the health strategy published in 2001, the former minister, Micheál Martin, promised the provision of 3,000 additional beds, but figures I obtained during the summer revealed that, since 2001, there had been a reduction of more than 15 per cent in the average number of beds at the Mater," she said.

Several opposition figures demanded that spare capacity in nursing homes be used as step-down facilities to stop "bed blocking'' by elderly patients who would be discharged from hospital if they had somewhere to go.

The next day, RTÉ's Liveline show decided to test the assertion that there were not enough nursing home places available.

The programme did a ring-around of nursing homes in the Dublin area and discovered that there was no shortage of spaces at all.

John Gormley of the Green Party immediately launched a broadside at Harney, arguing that the A&E crisis could be solved quickly if Harney were prepared to act immediately.

"There are now 209 vacant beds in nursing homes in the greater Dublin area. These nursing homes have claimed that they are registered with the Department of Health and have the beds and the staff to cater for the patients.

"The Green Party is now calling on the Tánaiste Mary Harney to accept this solution to the crisis and to act quickly to alleviate the suffering of patients and the hardworking medical and nursing staff," he said.

By Thursday, Fine Gael's new spokesman on health, Liam Twomey, himself a medical doctor, warned that the current overcrowding was likely to lead to increases in serious infections that are spread from patient to patient.

"The winter vomiting bug and the so called superbug [MRSA] are almost exclusively passed between patients attending hospitals. As a result of severe overcrowding, overworked doctors, nurses and other healthcare staff are experiencing difficulty controlling infections," he said.

He also drew Harney's attention to the shortage of appropriate cleaning staff, adding that this contributed to patients' chances of contracting illnesses while in hospital. He added to her unease by using his specialist medical knowledge to spell out in gruesome detail the nature of the threat.

"Patients coughing too close to each other could spread pneumonia and TB.

"Vomit - the winter vomiting bug - not being cleaned up properly, is not only distressing for the patient concerned, it could lead to the spread of diseases.

"The lack of cleanliness is especially dangerous in Accident and Emergency, where blood can spread diseases like hepatitis B," he said.

By Friday, with hospitals fearing a bumper harvest of accident victims over the bank holiday weekend, Harney was under even more pressure.

"At a time when the government is anticipating exceptional end of year exchequer returns, it is simply not acceptable for the Tánaiste and Minister for Health, Mary Harney, to proclaim that no more money will be made available during the current year to combat the crisis in the Accident and Emergency service,'' McManus thundered.

Harney's tactic is simple: soak it up now and implement changes that will bear fruit in time for the election. Were she to view the health debate exclusively through the somewhat cynical prism of the election, her priorities as Progressive Democrats leader would be straightforward.

Most PD voters or likely voters are wealthy or at least middle class.

The vast bulk of these are covered by VHI and Bupa Ireland or will be covered by the new insurer, Vivas, which is in the process of building its business.

This means that they do not suffer due to waiting lists. The whole point of private health insurance is that one can skip the queue.

In fact, the only time these voters ever come in contact with the public health system is when they have an accident, and must visit the hospital casualty department.

If she does nothing else, Harney must convince these voters that she is competent - a core PD value - and solve the A&E crisis.

For ideological reasons, this will probably mean she will involve the private sector as much as possible in the solution.

Rather than allow the health boards to roll out more step-down facilities themselves, for example, she will probably make them contract out such services to private nursing homes.

But suppose Harney succeeds in clearing the "bed-blockers'', hiring more nurses and finding away to clear out the drunks and junkies from the waiting rooms.

Middle-class voters, who now avoid going to casualty unless their limbs are actually severed, will start once more to use the facility funded by their taxes. The numbers attending will rise, and the capacity problems will start all over again.

Then the prospect of a June 2006 election will come into the Taoiseach's view, too early for Harney, but just right for Special Savings Incentive Account (SSIA) cash to start flowing into the voters' pockets.