James Reilly is under tremendous pressure within the Department of Health. So he should be. Management of the public health system by the Minister has been, to put it mildly, disappointing. His undertaking to establish a universal healthcare system within 10 years based on medical need, rather than ability to pay, looks increasingly threadbare because of legislative delays, complex administrative issues and reductions in Government spending. A promise of "free" GP care for all by 2016 appears problematical.
Micheál Martin discovered at first hand why former taoiseach Brian Cowen had described the Department as “Angola” (the large number of landmines) when he served as minister in the early 2000s. Mr Martin was glad to leave. It may account for the Fianna Fáil leader’s decision not to table a Daíl motion of “no confidence” in Dr Reilly, even though he publicly sought his resignation. The intervention has, however, ratcheted up pressure on the Government.
From a pre-budget situation where Fine Gael and Labour Party ministers were briefing fiercely against each other over funding for the departments of Health and Social Protection, by yesterday's Cabinet meeting, the government wagons had been circled. Dr Reilly had the "full support" of Labour ministers and he was cheerfully acknowledged to be doing a difficult job well. For his own part, Dr Reilly was happy that Taoiseach Enda Kenny and Minister for Public Expenditure Brendan Howlin would scrutinise figures for projected savings within his Department.
Tuesday's public protest by pensioners over their reduced eligibility for medical cards and the loss of telephone allowances gained little political traction when Ministers insisted that budgetary decisions would stand. Details regarding other health cuts may, however, be more contentious. The Health Service Executive has been directed to find savings of €666 million in the coming year. It will draw up a service plan to give effect to that instruction during the coming weeks while, at the same time, providing for additional services. In a post-budget briefing, Dr Reilly admitted there could be a cost over-run of €150-200 million.
This Government – and Dr Reilly in particular – promised a great deal, but delivery has fallen short. The job of transforming a two-tier system, with its in-built vested interests, into a universal health insurance model along Dutch lines is daunting. Timeframes have slipped, necessary legislation has been delayed, and envisaged savings on drugs and other items have not materialised.
There have been some positive developments. The establishment of Hiqa, the patient safety authority, has improved oversight and raised the prospect of accountability and better treatment for consumers. The number of patients occupying hospital trolleys has fallen. And children under six may get free GP care next year. These changes are notable as budgets are cut and services contract. But fundamental structural reform remains elusive.