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The appointment of Green Party ministers to deal primarily with energy, the environment and local government is a clear signal that the Greens’ strategy is to try to make a difference in a few key areas that are close to its heart, rather than spreading itself thinly across too many policy sectors.

On health, the programme for government has almost no green fingerprints, but all the hallmarks of the outgoing administration. Reforms already in place will continue, and there will be a few new radical initiatives. Chief among these is the ‘personal health check’, which is expected to be operating by 2012, and is to be started soon after new evidence-based guidelines are drawn up by an expert group.

The idea is men and women reaching a certain age will be invited to attend a primary care clinic or GP for an examination. Where there are concerns, they are referred immediately for specialist care.

There are promises to develop a “code of practice”, to tackle binge drinking, and to “consider” campaigns highlighting the dangers of alcohol abuse- all worthy, but woolly. Then again, we’re not quite where the Russians are, where impoverished men are now dropping in record numbers because the tax on booze means its cheaper to swig Brut.

On primary care, though, the programme is more specific. The €2 billion investment in the national development plan is to continue, with 500 primary care teams to be funded by 2011. GPs working in, or thinking of going to, remote and disadvantaged communities, are to get all sorts of supports, including more start-up funding for premises, equipment and cover.

Indexed thresholds

On medical cards, the income thresholds are to be indexed to the industrial wage, while steps are promised to promote greater take-up. That hospital policy is to be implemented as previously planned, is reflective of power sharing in the new Government and that it is impossible for the Green Party to scuttle co-location.

The smaller party has been spinning it that the policy has been watered down, but the programme for government reflects the dominant view that co-location is the quickest and most effective way of delivering most if not all of the 1,500 public-only beds promised.

The commitment to double the number of hospital consultants is explicit, but so too is a determination to impose a new contract providing for round-the-clock cover and contracted time to be personally worked, should negotiations founder.

The programme breaks new ground in the scope of services being considered for outsourcing through the treatment purchase fund. Among these are occupational therapy or speech and language therapy services for children under five who are waiting more than three months, and orthodontic services for kids who have been waiting longest.

There is a promise to make a written offer of treatment from the fund to anyone who has been waiting more than three months, and measures are to be taken to give patients greater access to data about waiting times.

Radical measure

The most radical measure is the proposal to use the fund to purchase long-term care, step-down beds and rehabilitation services. In 2008, an extra €20 million is to be ring-fenced in this way, and it looks as though some of this could go on the provision of new community nursing units.

Despite widespread public dissatisfaction, and indeed serious concerns among its own staff on its ability to get things done faster, there is no appetite for further structural reform at the Health Service Executive (HSE).

The HSE will be reviewed at some future time, and staff are to have an opportunity to contribute their views on how things should change, but this is nothing more than had been planned before the election. Reform is more than musical chairs or else changing the name over the door would serve no purpose.

Critical driver

In any event, the monitoring and regulatory role of the Health Information and Quality Authority is the new critical driver, which will have bearing on how well health services will be provided.

This programme is about keeping the health services steady. Its focus and thrust reflects the numerical strength of Fianna Fáil, the willingness of the Progressive Democrats to take on a job nobody else wants, and the reality that the Greens are clever enough to stick with what they know best. Which is why health was never going to be their deal-breaker.