THE latest joke doing the rounds about the Irish health service is that there is no point in rearranging the deckchairs – they have already been pawned.
Expect more of that kind of wisecrack in 2013 about an area of life that can have us mourning and marvelling all in one day.
Beyond the tears, sorrow, triumph and joy are the home truths, guidance and lessons we can take from the wider world of health here and abroad in 2012.
If the new year is all about goal-setting, then what has made us wiser as we embark on yet another makeover?
1. A spoonful of sugar does not help the medicine go down.
We are a nation of sweetaholics and the addiction is making more of us super-sized and fall victim to related diseases such as diabetes.
Michael Noonan was a poor Minister for Health in the 1990s. And while he has reinvented himself in recent years, his decision to block attempts to introduce a sugar tax on fizzy drinks shows that while he is trying to get the country into fiscal shape, his actions may end up expanding the nation's waistlines.
His objection on grounds that the drinks are already on the highest rate of VAT missed the potential impact of this tax on the psyche of many people who now, and in the future, will drain his Exchequer of hundreds of millions in health costs.
2. Beware of eating breakfast grapefruit if you are on certain drugs.
One of the most useful pieces of peer-reviewed research to emerge during the year was from researchers in Canada who shed new light on the possible side effects which eating grapefruit can have for people taking more than 85 different drugs.
These include drugs to treat cancer, high cholesterol, heart and blood-vessel conditions as well as prevent infections. Side effects can range from abnormally rapid heartbeat to kidney damage.
The advice is to always read the patient information leaflet with medication and talk to your doctor or pharmacist about any foods to avoid.
3. It is possible to reduce waiting times for public patients needing surgery.
For too long we heard the same excuses about delays faced by public patients needing surgery. Cuts in budgets and the ageing population was always part of the mix.
When Health Minister James Reilly set up the Special Delivery Unit in the Department of Health in September 2011 to drive down waiting times for hospital treatment, the inevitable focus was on the highly paid advisers he was hiring.
But credit where credit it is due. By the end of last October, the numbers on surgical waiting lists had fallen by 10,000 to 51,657.
The initial target for adults was to have nobody waiting more than a year and this has now reduced to nine months. While there are fluctuations in figures over the course of the year – with October showing a rise in the numbers of adults waiting over nine months and children over five months – the overall trend is one of consistency so far.
Changing work practices have been key to the improvement.
In 2013, the promise is that the waiting list of 388,000 people in queues to see a specialist will be tackled. Some of these patients are waiting more than four years.
4. Health spending remains in intensive care without a new Croke Park cure.
The health service pay bill will absorb more than seven out of every 10 euro from its budget this year, despite cuts in staff numbers through the moratorium on recruitment.
Without a new Croke Park agreement, and some room for manoeuvre in cutting pay for the huge numbers who are still earning Celtic Tiger salaries in the Department of Health and the Health Service Executive, real progress is being stunted.
There is still huge overlap at the top echelons. Do we need so many doctors in high-paying public service jobs? Just what are they all doing?
Staff earning €50,000 or more received €4m in increments to top up their pay in 2012. Yet, when it came to cuts, it was home helps' hours that were targeted in a bid to save €8m.
5. Highly paid executives running disability services must come clean on salary top-ups.
When the Irish Independent divulged for the first time in March the undisclosed top-up payments to a number of executives in the disability sector, it unleashed an unprecedented number of calls and emails. I received scores of calls daily for weeks afterwards.
It was thanks to an email by a vigilant civil servant in the Department of Health that this emerged after it was obtained under Freedom of Information legislation.
These disability organisations, which are self-governing, are receiving €1.5bn in state funding yet some chief executives on €150,000 are refusing to come clean on bonuses and other financial awards which are coming out of public donations.
Yet families and many vulnerable people with an intellectual disability are suffering a cut in services.
6. Patronising patients takes away their control.
We know that all well-founded studies show that the benefits of organised breast cancer screening programmes outweigh the risks. The screening saves lives.
If women are to take control of their health, they must be informed about the facts and the failings of any procedure. The belief has been that it is better to oversell the advantages rather than highlight the negatives which could scare women off taking up the invitation of a free breast X-ray.
But that takes away women's power to make an informed choice.
A major study in the UK last autumn highlighted some of the risks from screening. While they can pick up life-threatening cancers, they can also can result in many women being wrongly told they have harmful tumours.
But these minority of women can end up having a breast removed or undergoing treatment such as chemotherapy.
Failing to provide a clearly understood and unrestrained account of the downsides of any procedure is both patronising and unfair.