James Reilly – a year as health minister
So it’s just one year since James Reilly took up the mantle as health minister. What did he promise us and how is he doing?
To start, there is a BIG idea in the Programme for Government (PfG) on health which is universal health insurance (UHI). Specifically the PfG opening line states ‘this government is the first in the history of the State that is committed to developing a universal, single tier health services, which guarantees access to medical care based on need, not income’…. It goes on to talk about ‘reforming the model, more care in the community and reforming how we pay for care by introducing UHI’. So we have to give them that – the PfG and the minister want to signficantly change how health services are funded and provided.
However, then and now there is very little additional detail on it. It never planned to deliver UHI within their first term, but they said that legislation and ground work would happen in first term but the big idea would not be in place til 2nd term. Under UHI everyone would have access to both public and private hospitals, everyone would have the same coverage, 40% of those on lowest incomes would be totally subsidised, middle incomes partially subsidised, Critically Reilly sold it when Fine Gael’s FairCare policy was launched in April 2009 and in run up to election that ‘no one would pay more’ – anyone with insurance knows that everyone is paying more – last year health insurance costs went up between 15 and 45%.
But the big idea is health insurance under which every one would be covered and crucially have universal access to single tiered healthcare.
On Friday 24th February, the minister announced an implementation group, the first meeting took place last week. It took a long time to get the group in place so there is still no clear plan how we get from here to there and who’s getting us there. Some stepping stones are in place eg PfG committed to free GP care for all by 2016 and for those on long term illness (LLI) in first year by now – this is not achieved but promised by the summer, and those currently on the high tech drugs scheme are to get fre GP care in 2013 and then gradually all of us will but who or how again is not clear.
On the insurance front, there is no progress on insurance reform or even the type of model. Also one can not underestimate the resistance in the system to this type of radical change and without the detail and someone with a real knowledge of UHI doing it, it’s going to be hard to make it happen. Also one wonders about the lost opportunity of not doing more on it in early days of government.
The PfG also committed to a new special delivery unit (SDU), the minister’s nerve centre to drive reform. The SDU is charged to bring down wait times in Emergency Departments (EDs) and for public hospital treatment – with some success in EDs in December and January, yet numbers were last week very high again for EDs, the Mater hospital reached level four of its escalation plan last week and stories in the news about high numbers of children waiting in EDs.
The minister cut the wait times target down from one year to nine months, yet it was six months under previous government (although never achieved). The SDU have reduced the longest waiters but those under a year are higher than before.
In Dec 2011, there were over 60,000 waiting for day and inpatient treatment, while the numbers waiting more than six months for treatment at the end of last December were nearly double on the December 2010 figures at 11,688. Prof Michael O’Keefe spoke about cancelled surgery on the Pat Kenny show on 1 March saying ‘children will go blind or die’. James Reilly said last December that “Nobody is going to die because of health cuts” but we know that for some surgery must happen within a certain time – I am increasingly hearing specific incidents of urgent surgery being postponed as a direct result of cut backs,
It is very, very hard to do what they have set out to do in the PfG against a backdrop of taking €2.5 billion out of the health budget in the last 3 years, with 8,000 fewer staff, bed and ward closures. And although the focus on wait times in EDs and hospitals is welcome, it is useless unless you take all perverse incentives out of the system, and there is not much evidence of that happening, yet…
One of James Reilly’s most high profile commitments was to get rid of the HSE and he is busy doing that, the old HSE board stepped down last march (before they were fired), he appointed an interim board. The PfG said the ‘HSE will cease to exist over time, its functions will return to the minister and department’ – however in a way we are in more confusion now, Miriam Hederman O’Brien chaired Commission on health service in 1989 – said ‘the simple question who is in charge cannot be answered’ – that is truer now that ever before. At the last oireachtas health committee on 23 February, present were three health ministers, the HSE CEO, senior officials from the Department of Health and the HSE – over a dozen in total but it is not clear who is actually in charge. The minister says he is but under law the HSE is responsible for the money and services. A new law is needed to get rid of the HSE, this was meant to be published by last December, then early in the new year, now spring or summer… it’s complicated and obviously taking longer than expected, although no clarity about what happens the HSE when it is actually abolished, who and how will health services be delivered
Reilly is a relative new comer to politics, so is he doing as minister? On the one hand you have to give him credit for his drive to reform, in particular to provide universal access and UHI, for sticking to his guns, On the other, some of his pre election promises have come back to haunt him eg pledging not to close Roscommon Emergency Department or other units and now standing over their closure, promising to get rid of prescription charges and not doing so, pledging to cut consultants pay and then saying he will reform them under Croke park.
Also he has made some blunders – suspending the Fair Deal, the pre budget kite flying about widespread closures of community nursing units, also perhaps his political inexperience and naivety contributed to the excessive cuts landed on health in Budget 2012 – if someone else was at the cabinet table would health have got the cuts it did this year?
For his end of year one report card, I give him a B for enthusiasm and effort, a C for the work on bringing down waiting times, but a D overall for the big picture stuff as he has yet to pull off key parts of the big reform – the building blocks of reforming health insurance, what happens VHI, how we get to universal access… My reprot card comment would be he ‘works hard but tends to blunder through, needs to apply himself more, work out the detail, make sure it happens and bring people with him’