MARY HARNEY says she chose to be minister for health because she wanted to bring about real change in the health services. Specifically she sought to improve conditions in A&E, take on hospital consultants, reform the health system and create "a world-class health service". Fianna Fail and the Progressive Democrats campaigned for the 2002 general election on promises made in the 2001 health strategy. Five years on, almost all of their key promises have been broken, the health service is plagued by industrial unrest, inefficiencies and inequalities, and is increasingly being privatised by stealth.

Latest opinion polls show that over 60% of the population think the health service has got worse over the past five years.

Here, the Sunday Tribune examines the government's performance in Health.

1. WAITING TIMES FOR TREATMENT The promise:

"All persons will be given an appointment for treatment within three months of referral, " said the FF/PD Programme for Government. The 2002 PD manifesto promised "to end waiting lists".

The reality:

In 2002, patients were waiting years for medical and surgical treatment in public hospitals. Now, the average wait for the top 20 surgical procedures for adults is two to five months. Yet in 2006, 31% of adults waited over six months, while 33% waited over 12 months, for all surgical and medical procedures.

And these figures do not reflect actual waiting times, as waiting times for treatment in public hospitals involve two stages: the wait to see a specialist and the wait for whatever treatment is decided on after diagnosis.

The waiting time for public patients in the public hospital system is where Ireland's two-tier health system is most evident, with private patients being able to skip both waits: they are able to see a specialist sooner for diagnosis and then have faster access to treatment.

The verdict: promises broken

2. A&E The promise:

"We will implement a full range of measures to improve A&E services by significantly reducing waiting times, " the FF/PD Programme for Government said.

The reality:

In October 2004, a month after Mary Harney took up her post of minister for health, the Irish Nurses' Organisation started counting the numbers of people waiting nationally on trolleys in A&E departments around the country. On 27 October 2004 there were 186 people on trolleys, while on the same day in 2005 there were 257. On 27 October 2006 there were 134, which looks like an improvement. But on 21 February 2007, there were 412 people waiting on trolleys around the country, one of the highest figures ever recorded. On average in February 2007, there were 302 people waiting on trolleys each day in Irish hospitals.

On becoming minister for health, Mary Harney prioritised improving A&E. In November 2004 she announced a ten-point plan to address problems in A&E. In January 2005, she said, "People will judge our health services by Accident and Emergency. . . I expect real and measurable improvement to take place in the coming months in A&Ef A&E is a litmus test for me, for the government and for the people of our country." In March 2006, actor Brendan Gleeson articulated the nation's anger on conditions in A&E. Two days later, the Health Service Executive (HSE) announced the opening of admission lounges in A&E departments and 11 days later Mary Harney declared A&E a national emergency and set up a task force. The task force has reported but its findings and recommendations remain unpublished.

The verdict: promises broken

3. MEDICAL CARD ELIGIBILITY The promise:

In 2002, Fianna Fail promised 200,000 more medical cards and in November 2004 Mary Harney promised 200,000 GP-visit medical cards.

The reality:

In April 2007, 69,600 more people have medical cards . . . just 35% of the number promised by Fianna Fail, while 62,600 people have got GP-visit cards . . . just 31% of what Mary Harney promised.

GP-visit cards enable the user to visit the GP without cost but do not cover the cost of drugs, which can be prohibitive for people on low incomes.

The verdict: promises broken

4. HOSPITAL BEDS The promise:

The FF/PD Programme for Government promised 3,000 additional hospital beds over 10 years, 2,800 of which were to be inpatient beds and 200 day beds.

The reality:

Only 724 of these had been delivered by the end of 2005 (more recent data is not available). While only 200 day beds were promised, there appeared to be 475 additional day beds by August 2005.

But this increase reflected a new system of defining "beds" to include trolleys, recliners and couches. These had not been counted as day beds in 2001.

Recent census figures show that the population has grown much faster than was anticipated in 2002. The ESRI now estimates that 378 additional beds a year will be required for the next six years to meet public health needs.

The verdict: promises broken

5. MENTAL HEALTH FUNDING No promise:

While no specific promises have been made on mental health, the percentage of the budget spent on mental health has declined year on year for the past decade. In 2000, 8.1% of the health budget was spent on mental health services; last year 7.1% was spent. In Great Britain and Northern Ireland, on average over 10% of budget was allocated to mental health. Mental health organisations say the 150m budget allocated to implement the new mental health strategy, 'Vision for Change', over a seven- to ten-year period is totally inadequate.

6. PRIMARY CARE STRATEGY The promise:

"Twenty-four-hour GP cover will be extended throughout the countryf and a network of primary care centres where GPs, community nurses and physiotherapists work together to improve care for all groups, " the FF/PD Programme for Government promised.

The reality:

Five years later, 90% of the population has access to 24-hour GP services. Six years after the publication of the Primary Care Strategy, 10 pilot teams are up and running; 87 more were selected in 2006 (but there is no information as to where they are) and 215 are to be in place by the end of 2007 (again with no information as to where). The Primary Care Strategy promised an investment of 10bn. An additional 32m was allocated during 2006 and 2007 to provide for the establishment of the primary care teams.

The verdict: promises kept

7. CANCER CARE The promise:

"We recognise the particular need to ensure that people in all parts of the country have reasonable access to cancer services and will ensure this objective is achieved, " said the FF/PD Programme for Government, while the PD manifesto promised "regional cancer centres [would be] established so that patients do not have to travel 100 miles for ongoing radiotherapy". The targets set for cancer in the health strategy were to be achieved by the end of 2003.

The reality:

In 2003 and 2005, the government announced four centres of excellence for cancer services . . . two in Dublin, one each in Cork and Galway . . . with satellite centres in Waterford, Limerick and Belfast. In 2006, the government launched a Cancer Control Strategy.

The majority of promises made in these announcements have yet to be implemented. The position of director for cancer has not yet been advertised.

Many cancer patients have to travel over 100 miles for treatment.

Some cancer services are a geographical lottery depending on your address. For example, BreastCheck is currently available in the northeast, east, midlands and southeast, but is not yet in place in the western and southern regions of Ireland despite promises that it would be by 2005.

The verdict: promises broken

8. CARE FOR OLDER PEOPLE The promise:

"We will develop community facilities for the elderly, including community nursing units, in such a way as to actively promote independence, " promised the FF/PD Programme for Government.

The reality:

According to a recent study commissioned by Age Action, there are approximately 9,500 long-term beds for older people in the public sector . . . a total which has remained relatively static for the past decade. In contrast, the private nursing home sector has grown rapidly due to tax incentives, from 10,500 beds in 1995 to almost 18,000 today. However, as Leas Cross showed, such homes do not always supply the care necessary for patients with high dependency needs.

Under the former minister for health, Micheal Martin, there were government plans for public, 50-bed community nursing units, which would have met such patients' needs. An initial pilot project due to supply 850 such beds was not pursued by Mary Harney. The government has only recently revived plans to develop such units.

Meanwhile, when the HSE talks about additional public long-stay beds, this is frequently a reference to private nursing home beds contracted by the HSE for public patient care.

The verdict: promises broken

9. MRSA The promise:

"The key issue here is not funding: it really is about pride, standards and management, " said Mary Harney, four months after taking office as minister for health, on the best way to reduce the rate of MRSA infection in Irish hospitals.

The reality:

Government efforts to prevent the spread of MRSA have focused on cleanliness and hygiene and the appointment of infection-control managers. In 2006, 557 cases of MRSA were recorded in Irish hospitals. The 2006 research found that one in 20 patients in hospitals leaves hospital with a healthcare-related infection, while one in 200 runs the risk of becoming very seriously ill as a result of their stay in hospital.

International research shows that MRSA is closely linked to hospital occupancy rates of over 85%. Most Irish hospitals have occupancy of over 95%, while some are over 100%. Additional hospital beds and the availability of isolation units are key to reducing occupancy rates.

The verdict: promises broken

10. PUBLIC VS PRIVATE PROVISION The promise:

"We will seek to gain the maximum benefit for public patients from privatehospital capacity, " the FF/PD Programme for Government said.

The reality:

While the Irish health system has always had public and private elements, the FF/PD government has accelerated the privatisation of health services, to the detriment of public patients. Public patients have to wait longer to see a specialist, and then to receive necessary treatment, than private patients.

A Comptroller and Auditor General report published recently shows that the vast majority of public hospitals treat more than their allocated 20% of private patients. It found half of all patients being treated in some public hospitals were private, while the average was 30%. It found that "less resources than intended are being applied for treatment of public patients".

Not only do private patients receive preferential treatment in public hospitals, it is estimated that 40% or more of the cost of private care in public hospitals is subsidised by public money.

The FF/PD government has introduced tax breaks incentivising private hospitals and nursing homes. For every 100m invested, 40% is retrieved through tax breaks.

The plan to build 10 private hospitals on the grounds of public hospitals has caused particular controversy with little or no benefit to public patients or the public healthcare system.

The verdict: promises broken All information cited in this article is sourced from official government documents and from responses to press queries from the HSE and the Department of Health, unless otherwise stated.