What James didn't do and what Leo must do

  • Niall Hunter, Editor

It's all been very exciting hasn't it? A new health minister. Who's was it going to be? Wasn't James Reilly terrible? Will Leo be any better? Don't you just love celebrity politics?

Did you know James built two primary care centres in his back garden, and apparently, is sometimes a very rude man? OMG!  And he was apparently (pass the smelling salts) 'not politically astute' according to informed sources etc etc.

And now we have a new Minister, another doctor, Leo Varadkar, who for some time had been the most likely candidate to replace James Reilly when he finally got the heave-ho. He too is (oh dear) controversial and in favour of reform.

He too, despite good intentions, may well leave the Department of Health ultimately frustrated and widely criticised. Or he may perform miracles. Unfortunately, most political and ministerial careers tend to end in failure, especially for those brave souls who are called upon to hop through the minefields of 'Angola'.

Obviously, the Taoiseach hasn't opted for a 'safe pair of hands' to administer 'Angola'.

But let's get away from personalities.

Speculation about the cabinet reshuffle  has been accompanied by much frenzied hot air exhalation among the chattering classes. And that's all it has been really - hot air. Pretty much like politics in fact.

For ultimately, judging by James Reilly's tenure, being health minister these days is mostly not about making the health service better, but about 'I'm a celebrity', and eventually, 'get me out of here." In James's case, to a far safer Government department.

It's all about your personality, who you like and don't like, how things 'play out' in the media, what your current weight is, the state of your bank balance, and how good you are at 'playing politics'.

It all really should be much more boring. Being in Government is ultimately about changing things so that people's lives can be made better. It's about policies, not personalities.

In the heady excitement of the 'democratic revolution' following the February 2011 election we were promised radical new policies to improve our health service. Did this revolution take place?

Well, as a wise (and possibly genocidal) Chinese politician once said: It's too early to say. Mainly because there has been no sign of anything like a revolution over the past three years or so.

We have had only more of the same, and sometimes even worse than the disasters presided over by Mary Harney. And she would never have displayed the hubris and ineptitude her successor showed over the discretionary medical card debacle.

Being Health Minister is about policies, and implementing them. That's what Government's about. It's boring but its basically all about helping people.

It's about being honest with those who elected you and giving clear picture about how things are changing for the better. It shouldn't be all about strokes and spin and talking in circumlocutions and trying to save your political skin.

And let's be clear about one thing. James Reilly's very mixed and often poor record in health is not just his own record, but that of the current Government as a whole.

It was the Government that presided over unprecedented health cuts and allowed health to take a disproportionate share of an albeit very necessary national financial retrenchment dictated by the Troika.

It was the Government too, and not just Dr Reilly, who, when all else failed, tried to pull stunts that 'read well in the media' and with the electorate, it was hoped.

The latest manifestation of this is the ludicrous Government decision this week to give retired judges, hospital consultants, captains of industry and many other well-off 'golden oldies' free GP care.

This is only weeks after the same Government was allowing the HSE, as a money-saving measure, to take medical cards off people usually on modest incomes who had disabilities and other serious illnesses.

And still, vulnerable and sick people don't know whether they will qualify for medical cards under a new (temporary) system of granting a card based on medical conditions.

And, it should be pointed out, while many well-off over 70s will get free GP visits, others people on moderate to low incomes still have to pay for this service as they are not entitled to any type of medical card.

Roll on free GP care for everyone - if it ever happens, at least it will end these ridiculous ambiguities and complexities that cause much uncertainty and hardship.

This latest political and bureaucratic mess on medical cards is typical of Dr Reilly and the Government's hamfisted approach to running and allegedly improving the health service.

James Reilly has tinkered at the edges, made a lot of reform promises, has had some minor successes with public health policy and trolley waits, for example, but ultimately has achieved very little.

Rather than offering hope of a better future through his 'big project', universal health insurance, Dr Reilly and the Government failed to assuage public fears that this scheme will be unaffordable for both the average punter and the State.

His new ministry for Children and Youth Affairs is probably a better fit for him - fewer minefields with a role in public health policy and more likelihood of good news announcements. If he ultimately fails with policies on smoking, obesity and alcohol, he can always blame vested interests for preventing progress.

This is all very well for Dr Reilly, but as for Dr Varadkar, he takes over a health service that's still in a mess, run by a HSE behemoth that is deeply unpopular with the public, and with many of those who work for it.

Access to the service is still inequitable and unfair and navigating it is more confusing than ever.

Promised reforms, such as abolishing the HSE and replacing it with an even more complicated and potentially more bureaucratic 'quango'-filled system including hospital groups, a new commissioning agency, and with insurance companies probably running much of the service, do not exactly inspire confidence, however well-intentioned they are.

The new Minister will have his work cut out to deliver us from a nightmare on Hawkins Street.

Among his priorities should be:

* Set a realistic timetable and deadline for the implementation of free GP care for all to concentrate minds among the the Government, HSE and GP groups on building a system that will work and that will renumerate GPs appropriately. This is a reform that not all GPs might want, but the public certainly wants it and needs it. Medical card holders who currently aren't sure from one week to the next who is entitled to what will welcome an end to the eligibility lottery.

* Set a clear timetable for the introduction of UHI to allow for proper checks and balances and agreements with stakeholders to be put in place, and to allow the public to be reassured about how much this new system will cost. Consider changing the UHI system from a market-based one run by insurance companies to one run and properly regulated by the State.

* Never mind balancing the HSE's budget - this annual 'crisis', which always ends in a supplementary allocation, is of more interest to economists, the media and the Troika than the average health consumer. The simple fact is the health service does not get enough funding. There should be no more talk of 'doing more with less'- while there is still some waste and inefficiency, most of the savings that could be made have been made. Fight for a greater share of exchequer funds for health, which by the end of this year, will have had a quarter of its budget removed since 2008.

*Provide an implementation plan for transfer of adequate resources from hospital to primary care, and stop the lip service paid to this. Use any freed-up funding to incentivise and resource GPs to provide more services to keep more patients out of hospital. This will help reduce waiting lists/trolley waits etc.

* Launch an investigation of how the discretionary card issue was handled by the HSE and learn lessons from it. Remember, a senior HSE official recently said the way some reviews were conducted was 'indefensible'. There has to be some accountability, not just at political level, for the way the discretionary card issue was handled.

* Clarify who exactly will be running the health service up to and after the introduction of UHI. Currently, this is a greater mystery than the Da Vinci Code.

*Pending the introduction of UHI, provide ringfenced funding to cut back waiting lists, in order to get extra procedures done through the private and public sector. Waiting list funding has been cut in recent years, and despite some improvements, the lists have remained at a high level, particularly for outpatients.

* Look again at the plan for independent hospital groups/trusts. While this plan looks good on paper, there is potential here for State-funded hospitals to be given even more independence of action than they already enjoy (remember the recent top-ups scandal). Ensure that the State has proper control and monitoring of the hospital system under UHI.

* Fast-track a proper patient safety/ hospital licensing system.

* Examine the funding for mental health services and provide additional resources where necessary.

* Obviously, if extra funding is needed for the health service, ultimately, the money has to come from somewhere. Start a public conversation on the fact that if we want a better and more equitable health service, we will eventually have to pay more for it, whether through insurance/taxes etc. The public may be more receptive to this than you might imagine if it can be reassured that excess costs can be controlled.

And good luck with all of the above Leo!

Varadkar is new Health Minister


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