SOME POLITICIANS might dream of staying in the headlines every day, but not if it involves the kind of publicity that Minister for Health James Reilly has been getting of late.
On his watch as Minister over the past 18 months, the health service has lived up to its reputation as a place of intrigue, wracked by divisions and beholden to vested interests.
Angola Mark 2 is the nickname of choice these days for the Department of Health, which was first likened to the African country by former minister Brian Cowen for its ongoing obsession with political infighting.
Last week was another bad week for Dr Reilly, one which began hopefully with a long-overdue deal with hospital consultants over working hours but ended with the Minister losing while explaining his decision to site two primary care centres in his Dublin North constituency.
That controversy refocused attention on the dire relationship between the Minister and Labour Minister of State Róisín Shortall, who did most of the spade-work in selecting priority locations for primary care centres and was not best pleased to see this overturned by her boss in Hawkins House.
The continuing rows between Dr Reilly and Ms Shortall are usually depicted in terms of a personality dispute, and there is no doubt that the two are ill-matched to share a room, let alone a Government department. However, there are serious policy and ideological issues that divide the two politicians, as Ms Shortall identified during her speech in the no confidence motion in Dr Reilly during the Dáil last week.
Ms Shortall wants an emphasis on State-run and developed projects, priority given to deprived areas and the maintenance of current entitlements.
Dr Reilly prefers more private sector involvement and has shown great forbearance with drug companies and consultants in the light of the urgent need to make cost savings.
The rest of the Cabinet, conscious of the unrelenting focus on problems in the health service, just want the two to get on, a wish unlikely to be granted anytime before or after Christmas.
Meanwhile, Dr Reilly’s personal business issues haven’t gone away. Having made an unwelcome and unprecedented appearance in Stubbs Gazette earlier this year, he has yet to succeed in divesting himself of his share in the Co Tipperary nursing home that caused the problem. Dr Reilly has also been unsuccessful in trying to sell off his share of a primary care site in Swords which is probably worth a fraction of what he paid for it.
The scale of the challenge facing the Minister was set out by department secretary general Ambrose McLoughlin during the week, when he explained that €2 billion had to be taken out of the health budget by 2014. In the circumstances, the system isn’t doing too badly in delivering “more with less” but it’s hard to see any health service could survive the strains of such shrinkage, let alone one expected to deliver the Minister’s ambitious plans.
Perhaps it is not surprising, despite what Dr Reilly says, that some of these plans are falling behind schedule. The first phase of free GP care was due last March, but has yet to materialise. Promised and very necessary savings from drug companies and insurance providers have been slow to come. A decision on the site for the new national children’s hospital has been deferred for months.
Some actions have been taken to reduce the deficit, projected to reach €500 million by the end of the year. Agency and overtime spending is being slashed, supplies are being run down to a minimum and non-essential expenditure is being pared to the bone.
Waiting times have generally fallen since Dr Reilly came to office – the number of patients on trolleys, for example, is down 20 per cent since the start of last year – but much of this has been achieved by channelling large sums of money through the new special delivery unit. The question is whether these improvements will survive the removal of funding in the future.
The furore earlier this month over cuts announced by the HSE led to a reversal of the decision to reduce personal assistant supports. Weeks later, other measures, such as proposed cuts on home help hours, remain under review. And rather than announce what impact agency and overtime cuts will have in the regions, HSE officials have been told to remain schtum.
But just because something hasn’t been announced doesn’t mean it isn’t happening. Every day, reports are coming of new cuts to patient services around the State – beds here, oxygen supplies there, food supplements somewhere else. And, as the cuts bite deeper, and services are run down further to make end-of-year savings, people will begin to react.
We are, as the Minister himself has said, approaching a “crunch time” for a health service which is stuck “between a rock and a hard place”.
