If the day finally comes, and God knows it's been predicted for long enough, when James Reilly gets to ask Enda Kenny why exactly he's being sacked or shifted sideways, the Taoiseach will simply have to point to the latest performance report from the HSE.
This report, published in recent days, provides a succinct summation of much that has gone wrong with Dr Reilly's troubled tenure in Hawkins House, and may indeed serve as his political epitaph when that post-local and Euro elections cabinet reshuffle takes place.
A worrying seam running through the report is an ever-shrinking HSE budget, and ever-increasing demands on services.
This of itself is not necessarily surprising given the state of the economy in recent years.
However, the growing scale of the cuts to the health budget and related concerns about patient safety, the increasingly poor performance of the Minister in managing this budget, and the lack of success of his initiatives to make savings could well mean that Dr Reilly will be shuffling off his ministerial mortal coil quite soon.
More than anything else, the report highlights that despite all the spin about cutting waiting lists and improving access, our health service is still a two-tier access system.
The number of people waiting over a year to see a consultant in a public outpatients has increased by 230% since the end of last year.
Announcing a major drop at the end of last year to only 4,000-odd in the numbers waiting over a year for an outpatient visit, Dr Reilly said this represented 'real progress in our health system'.
Since then, in then space of only three months, this waiting list figure has increased by 230%. Not much progress there.
It transpires that the bulk of this waiting list reduction was achieved last year by a once-off purchasing of services from private hospitals. The increase since then highlights exactly how much public hospitals are finding it difficult to cope with increasing demands against continually shrinking budgets.
Many hospitals now complain that they have made efficiencies, and trimmed off as much 'fat' as possible in recent years - now they simply do not have enough money to provide adequate or in many cases safe services. The HSE/Department of Health response to this plea has been to tell them to rein in their budgets even more.
Here are some lowlights from the HSE performance report.
* The HSE will not be able to achieve the Haddington Road Agreement pay savings target.
* The Minister's initiative to charge all private patients in public hospitals for their accommodation, even if they occupy a private bed, is coming unstuck. The HSE says the targeted income under this measure is not materialising.
* Targeted savings under the Minister's initiative to save money by introducing a 'nurse bank' staffing initiative are being called into question, as are savings expected under the controversial graduate nurse recruitment scheme.
* A savings target relating to the licensing of tobacco retailers is dependant on new legislation being introduced and therefore these savings may be delayed.
* The report says the scale of the medical card scheme savings target for 2014 of €294 million is 'a very significant challenge'. The medical card service savings measures include medical care 'probity' targets, the report says. 'Medical card probity' involves reviewing eligibility and in some cases taking medical cards off people.
While in the scheme of things, the actual number of 'indefensible' cases where patients in great hardship have lost their medical card is relatively small, for the individuals concerned and for the political establishment quite rightly blamed for it, the fallout from this issue has been huge.
What adds to the bureaucratic heartlessness involved with the discretionary medical card issue is politicians and officials admitting recently that what was being done was wrong in many cases, while showing little sign of doing something to right that wrong.
And, perhaps most telling of all, the HSE points out, in its report, that by the end of 2014, a massive 27% cut will have been made in the health budget since 2008.
There are a number of questions here. How can any health system, regardless of some efficiencies that would have been made as a result of the drive for savings, continue to provide a safe service when close to one-third of its budget has been removed?
How safe or equitable is a system that removes health entitlements from a disabled person? How safe or equitable is a system that forces some sick public patients to wait two years or more to see a consultant, or cause public patients to have their operations cancelled due to lack of resources?
Why has the Minister seen fit to preside over a disproportionate share of health service cuts in recent years as part of the Troika programme, and why are these cuts continuing at a greater level than ever, now that the Troika has left town?
The HSE performance report shows that health spending in the first quarter of this year was €2.97 million, compared to €3.08 million in the same quarter last year. However, it only had a budget for €2.88 million, leading, not surprisingly, to a spiralling deficit which will require yet another bail-out at the end of this year.
After six years of health austerity, how can any Health Minister persuade the public that this level of health spending against a background of rising demand can guarantee a safe health service?
Yes, safer healthcare isn't all just about funding the system properly, but how can any system that denies treatment or services to vulnerable, or sick, or poor people be regarded as safe?
The Minister himself has admitted recently that €100 million or more in health savings this year are not achievable. If he had some inkling of this when the estimates were being drawn up late last year, why didn't he fight for a less draconian share for health services of the cuts being dished out?
And if he found he had little or no power to stop this level of cuts from being imposed by the Government, why didn't he resign in protest?
The gradually fading promise of free GP care for under sixes and others at some time in the future, and eventually, universal happiness insurance for everyone in 2019, has done little to ease public concern about the state of our health services today.
Perhaps Dr Reilly might reflect on these issues, before, as is now looking more likely, he is finally shown the door.
HSE faces financial meltdown
230% increase in outpatient lists
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