We get the Government we deserve. That old truism was brought to mind when the Minister for Finance, Charlie McCreevy, published the Book of Estimates last week.

This is the document which sets out the spending targets for the various government departments over the next year. It is a hugely important document, defining in so many ways the likely quality of services – and by extension, the quality of life – that will be available to the majority of ordinary people over the year ahead and into the medium term future at least.

So what has Charlie McCreevy got in store? Having sanctioned massive increases in public spending over the past number of years – and having bought victory in the last election with the largesse he was dishing out in the process – he has now decided that increases in spending in the coming year must be kept within 2%.

With the rate of inflation running at approximately 4%, that means an effective drop in spending, by the Government, in real terms, of 2%. Already, the effects are being seen. Overseas aid is being chopped by a whopping 15%. The Arts Council budget is being cut, meaning that there will inevitably be less money available for grants to artists. And so on…

You might recall that in the run-up to the last general election, the same Minister McCreevy busied himself in the task of rubbishing any suggestion that the economy was in trouble, and promising that there would be no cuts in government spending – because no cuts were required. Well, I know that Charlie is fond of the ponies, but I didn’t think he was in the business of producing horse manure by the truckload. Unfortunately, that’s what his reassurances have turned out to be.

I don’t want to go on about this – it’s boring stuff. But it is worth saying that anyone who bought the Fianna Fail line at the time must have been a complete plonker. It is clear that they set out to deceive the electorate. But did we have to be so easily fooled? Enough people bought the bullshit to return Fianna Fail and the PDs to power, effectively rewarding five years of mismanagement of the economy with a further term of office.

It should be a salutary lesson. But it is one that will almost certainly be forgotten by the time the next general election looms. Unless they have succeeded in completely bankrupting the country in the meantime – which has to be a real possibility, given the extent of their failure when the times were good.

Nowhere is the inability of those charged with the running of the country more obvious that in the appalling state of the health services. This is something that affects people on a daily basis, especially those with any kind of long-term or recurring illness.

At the weekend, the Sunday Tribune stated that there were now 100,000 employees working within the health services here. This is an astonishing number, representing over 2.5% of the entire population of the Republic. More money than ever is being spent through the Department of Health – with increases of 8% provided for in the Book of Estimates. Now, I wouldn’t begrudge this even for a second, if it gave us what that level of commitment should allow us to create: one of the best health services in Europe.

Instead, what we have is a disgraceful mess – a service that is riven with turf wars, and disabled by a lethal combination of bungling and bureaucracy. I have been close to a number of difficult medical situations over the past year and more. One of these has involved a man in his 80s who has had a serious heart condition for many years. His medical records are all in St.Vincent’s Hospital, to which he went with his first heart attack some 30 years ago. This is where he goes for his long-term ongoing care. It is where his responses to the drugs he is taking are monitored. Everything that anyone needs to know about him, in the event of an emergency, is there.

He lives in Dartry. He has collapsed on a number of occasions over the past two years, and it has been necessary to call an ambulance on many of these. However, the ambulance drivers refuse to take him to Vincent’s – despite being told that all of his records are there. This, apparently, is because James St. has now been designated as the hospital for the ‘catchment area’ into which the road on which he lives falls.

On a number of occasions, there have been stand-up arguments with the drivers. For a time, they would agree to change destination – but only if they got specific instructions from the Accident and Emergency in Vincent’s. On occasion, this led to the absurd situation where they waited in the ambulance for up to 30 minutes, outside the house, with the patient inside, while they made efforts to re-confirm the hospital’s agreement that he could be brought there. To describe the scene as deeply stressful, for both him and for his family, is to understate it massively.

People in Accident and Emergency in both hospitals are clear that this is all about politics. They are ashamed and embarrassed about what the patient is being put through. But rather than the problem being rectified, it has got worse. Recently, the family were told that no one in Vincent’s (and presumably the same applies in other hospitals) can now give the drivers authorisation to take the patient to anything other than the designated hospital.

There, in James St., an 84-year-old man with a serious heart complaint, having collapsed, is forced to spend endless hours – sometimes it might be days – on a trolley. Twice he has insisted on being discharged, to get away from the appalling conditions in accident and emergency in James St. (which is another story entirely). Having been, he insists that he would prefer to kick the bucket than to endure the misery of a night there.

It may have its new enclaves, which do not feel quite so desolate, but being next or near A&E there is a grim experience. The situation is similar in other hospitals, in Dublin at least. The health service is in chaos. The system is in a state of ongoing collapse. And it seems that no amount of money can solve the problems, so deeply rooted are they.

There is, of course, a way – but it would take a level of political courage and determination, which is almost certainly beyond those who are currently in charge of the Department and of the public coffers generally.

Dr. John Crown, a consultant oncologist at St.Vincent’s Hospital appeared on the Pat Kenny Show on RTE radio recently and his comments got to the heart of the matter.

What is needed is a complete reorganisation of the entire service, on a national basis. There are currently ten separate health boards, and each of these has its own huge bureaucracy, creating crazy inefficiencies, which soak up vast sums of money that would otherwise go towards patient care. It is essential that they should be disbanded, and that a streamlined structure be put in place instead.

Anyone with a bit of cop knows this. But the Health Boards are weighed down with political appointees, and there is a level of self-protection and self-perpetuation in-built that makes the prospect of trying it a daunting one for any politician.

It is, however, the only way to go. Tinkering with it is useless. People are entitled to be treated with a bit of dignity when they are sick, and that is being denied to them at the moment, in a way and to an extent that is a disgraceful indictment of everyone concerned. It should not be allowed to continue.

So, let’s see if anyone has the bottle to sort it out.

But don’t hold your breath. You might need to call an ambulance – and who knows where that will take you?