Mistletoe and whine

Terence Cosgrave takes stock of the events of 2009, and predicts another difficult year for the health service

As we come to the end of 2009, most would agree that the year has not been one many of us will remember with fondness or warmth.
The revelations of child abuse in State institutions in the Ryan report, which were revealed in the middle of the year, came on the back of some of the worst economic news we’ve experienced in this country.
It was as if when we thought things couldn’t get any worse, a new level of ‘how bad things could get’ began to appear.
We may be paying for many years for the recklessness with which the banks threw money around during the property bubble/boom, but it is nothing to the scars (sometimes literal) left on those children who were tortured and abused — mainly because they were poor and had no parents or family to look after them.
And as the detail of this terrible abuse began to surface, people were losing their jobs on a vast scale. Many believe that we still haven’t understood the sheer number who have lost their jobs because the safety valve of emigration has had an effect in reducing overall numbers out of work.
And then the floods hit — almost like a Biblical calamity.
And now we have Budget measures which will affect every home and individual in the State. And even if we manage to navigate our way out of these current cutbacks and stern economic measures, we’re due for another round next year, and the year after that, and the year after that.
The change in our circumstances is profound, and it will have a huge impact on how health services are delivered in the future.
We now have to face the fact that the opportunity for planned and painless strategic reform — which might have been achieved in the boom years — has passed. And yet we still have a desperate need to reform the public services in general and the health service in particular.
Since it has been the case that many reforms simply weren’t achievable when there was a huge surplus in funds, it may be that some things which weren’t possible then are possible now.
Certainly we can’t wait until money becomes available to enact reform in the health service — that would be to put off any progress indefinitely.
We are facing into an extended period when less funds will be available for the health services and every other government department.
Hopefully, as a nation, we will decide to spread those funds as fairly as possible. And hopefully, as individuals, we can accept some sacrifices for the greater good.
But somehow I don’t think the Christmas spirit will last very long into 2010.