First the good news (and it's long overdue). The deal worked out this week between the Health Service Executive (HSE) management and hospital consultants over pay and work practices should not be underestimated in its impact on the State's finances (reckoned to save up to €200 million in a full year) and on the day-to-day working of the health services.
Although the deal is a tentative one and still has some detail to be worked out, it is nonetheless welcome. Because the savings will not emerge in 2012 (we'll have to wait until next year for tangible benefits on the money front), we all still have to face up to the €500 million deficit in the health service.
The great sticking point from the consultants' side was the vexed question of rosters. It has taken four years to inch towards any resolution of this question but the acceptable side of the wait rests on the fact that this latest deal has been done without major industrial relations upset, something that would have alienated the general public (many of whom are patients) and damaged the image of the health service.
Working out acceptable work rosters in any enterprise can be a sticky and complex operation and many a deal has become unhinged when the reality of the day-to-day grind sinks in. However, we should be optimistic that the deal is in the interests of the State, the patients and the medical profession itself.
The "new reality" about Irish pay rates has sunk in at last. Minister for Health Dr James Reilly has been widely criticised for alleged failure on a number of issues relating to his portfolio, yet he has landed the "big fish" (without the agreement of the Irish Medical Organisation and the Irish Hospital Consultants' Association) - the introduction of new consultant medical salary rates about 30 per cent less than current holders of these posts. Who can complain about that?
Yes, it is true that new entrants will be working alongside colleagues who hold onto "historical" rates of pay but this will even out over time as a result of retirements and other developments.
Now for the not-so-good news from Meath's point of view.
I don't have much time for parochial defences of hospitals or any other institutions unless there is a very good reason for their retention. But the future of Our Lady's Hospital, Navan, has exercised the minds of the people who work there, and, more importantly, the minds of the general public who woke up to the fact (in 2010) that their hospital truly was in danger of being seriously downgraded, if not closed.
Ten thousand Meath people took to the streets of Navan to voice their opinion on such an outcome. Yet, the downgrading has continued apace.
It appears that people are still pretty alert to what is happening their local hospital. Otherwise, the Newgrange Hotel would not have been full last week when the Save Navan Hospital campaign called a public meeting.
Several people at the meeting spoke of their experiences while patients at the hospital and none of them had a negative outcome. They were all treated with professionalism, great care and consideration.
In other words, Our Lady's Hospital WORKS. I am being careful in the words I use about Our Lady of Lourdes Hospital in Drogheda - the staff there are, without exception, professional and diligent people (albeit run off their feet) but the hospital's services are swamped and it is faced with further cuts in the next few weeks, on top of cuts already implemented.
It is neither today nor yesterday that it was decided that Drogheda and Cavan hospitals would provide the acute medical services for the region. That plan goes back a long way.
But it does not take into account that this kind of service should in some way be augmented by the work of smaller hospitals, including those in Navan, Dundalk and Monaghan.
We fear the (still suppressed) Small Hospitals Review Document mentioned at last week's public meeting in Navan. The activities at nine hospitals, including Navan, are under consideration in this review and the prospect looms that further savage cuts may be on the cards in Meath.
We hope not, but fear the worst.