At the May 2002 launch, Bertie Ahern said Fianna Fail was committed to "full implementation" of the "most ambitious ever health strategy". Minister for finance Charlie McCreevy said health spending would be the government's "number one priority", even if growth slowed. In a display of unity, Ahern was flanked by McCreevy and minister for health Micheal Martin, ministers who had disagreed over funding health.

Fianna Fail was campaigning on the 2001 Health Strategy, the Taoiseach made clear.

The 10-year plan published six months before promising 3,000 public hospital beds, up to 600 primary care centres, 5,600 long stay beds for older people . . . that was Fianna Fail policy.

Fianna Fail would "permanently end waiting lists by 2004", Martin promised.

"Micheal Martin has put so much commitment into this document, I would genuinely love to see him get five years to implement it, " Ahern enthused.

The election was in June. The government increased hospital charges in November; froze public health employment in December; and, through the winter of 2002-2003, cut spending on hospitals. Over 180 beds were closed in acute hospitals in the east in some months in 2003. Health boards cut home helps. New public facilities costing 400m were idle in 2003 and 2004.

By autumn 2004, there was outcry over elderly patients spending five nights on trolleys in squalid, overcrowded accident and emergency departments. The consequences of abandoning the strategy were manifest.

Ahern then replaced Martin with Progressive Democrat leader Mary Harney. The Taoiseach would have looked far to find a minister whose political philosophy was more inimical to Martin's envisaged investment in public health care. Harney promised measurable improvements in A&E. Without significant expansion in public acute or longstay facilities, the new Health Service Executive (HSE) was under pressure to hasten the departure of elderly patients from acute hospitals into private nursing homes. Not all offered suitable care, as Leas Cross illustrated within months.

By summer 2005, Harney had instructed the HSE to invite private hospitals to locate on public hospital sites, insisting this was the strategy's public expansion.

Now, in May 2007, with health again exercising voters, the opposition parties argue for the kind of public investment that Fianna Fail promised five years ago.

What happened to the Health Strategy? In 2005 the Irish Congress of Trade Unions invited US health economist Professor Dale Tussing to answer that question among others. I joined him in that study, published last year. The picture was and is clear. The strategy has not been implemented.

Acute beds Take acute beds. The strategy promised 3,000, based on a study recommending 2,800 more inpatient or overnight beds and 200 day procedure beds. A welter of confusing claims followed. The Taoiseach announced 900 new beds, then retracted this claim. Harney insisted that her department did not describe trolleys or recliners as beds. Her department issued its new definition of a bed, which includedf trolleys, recliners and couches. By last November, Harney claimed, answering a Dail question: "the government's commitment to increase total acute bed capacity is virtually complete".

Of the 2,650 beds she enumerated, only some 600 were real, tangible beds. The remainder might charitably be described as 'virtual' beds:

day beds discovered when trolleys, recliners and couches were redefined as beds; beds 'in various stages of planning and development'; and beds in proposed but non-existent private hospitals.

Now Fianna Fail's 2007 manifesto claims 1,600 additional acute beds "over the last 10 years". This claim translates into approximately 720 additional beds in the five years since 2002, after subtraction of some 550 discovered trolleys, recliners and couches and 330 inpatient beds added in the government's first term.

Harney last week attempted to trump Fianna Fail, claiming 2,000 beds over the last 10 years, 400 more than claimed by her government partners. She contrived this by quoting a 2005 HSE bed count, 420 higher than her department's count, measured differently and invalid for comparison with ten years ago.

The Taoiseach recently told a newspaper "we've gotf a lot of new hospitals". No new public acute hospital has opened in the last five years. The new general hospitals have been private and generously state-aided . . . the Galway, Beacon and Hermitage Clinics.

(Existing hospitals like St Vincent's and the Mater have been expanded or rebuilt. Cork has a new maternity hospital. ) A picture of inflated claims, targets missed and projects abandoned extends across the system. The Strategy promised 800 extended care or community nursing unit places each year for seven years . . . 5,600 in all.

In July 2002, Micheal Martin announced 17 community units to provide 850 beds. They never happened. Only recently has the HSE detailed a programme of such developments, some "advanced", none yet a reality.

Medical cards Fianna Fail promised 200,000 medical cards.

Thirty-five per cent have been delivered. Harney promised 200,000 doctor-only cards in 2004. Thirty-one per cent have been delivered. Only 26% of the population qualifies for free medical care on low income grounds compared to 35% a decade ago. A study found that 18.9% of patients with medical problems have not consulted a GP because of cost, compared to 1.8% in Northern Ireland.

At the end of 2003, the government transferred responsibility for waiting lists from the Department of Health to the National Treatment Purchase Fund.

For three years it published no national data. An end to lists but not to waiting. In December 2006, the NTPF revealed that 22,223 public patients were waiting over three months for surgery or medical treatment, of whom 34% had waited over 12 months. This count did not include waits, often years, to see consultants.

Trolley counts Strategies to lower the trolley count make health management a numbers game. Frail, older patients are moved from public hospitals to private hospitals.

Surgical procedures are cancelled to free beds for non-surgical patients on trolleys.

The government cannot blame inadequate resources for its failures. Tussing and I costed the major Strategy commitments.

They are wholly affordable. Funding 3,000 hospital beds, 550 primary care centres, and 5,600 long-stay beds over 10 years would double health investment, bringing it to 1,100m per annum in 2005 prices, still only 12% of public capital investment in 2005 compared to 27% for roads and transport. Staffing the acute and longstay beds would add some 10% to current spending on health by the end of 10 years, not even bringing core health spending to the western European average.

OECD data show that Irish current spending on core health programmes peaked at 92% of the EU15 per capita average in 2002, fell to 88% in 2003 and was 90% in 2004, the latest year of available international data. There is no evidence that health spending has since advanced relative to the average.

Government parties argue for locating private, for-profit hospitals on public hospital sites, to remove private patients from public facilities. Yet doctors warn that many privately insured patients, with conditions unsuited to straightforward elective treatment, require public hospital care. Thus, new private hospitals would not free many public hospital beds for public patients. Instead, at considerable expense to the state, they would create more private beds and profit, while public hospitals are denied much-needed investment.

Stand-alone, private hospitals play a role in equitable, universal health care systems, as in Canada or France. Fine Gael, Labour and the Greens support phased introduction of a universal health insurance system. But the government is not proposing reforms to create an equitable system, accessible on the basis of need. At the last election it offered a programme of investment . . . and it has not delivered.