Minister’s fantastical figures
Minister James Reilly’s budget shenanigans have put him right back in the spotlight. See my column for Medical Independent from 7 November 2013. A cliché is defined as: “A sentence or phrase, usually expressing a popular or common thought or idea.” It is also explained as one “that has lost originality, ingenuity, and impact by long overuse, a trite, stereotyped expression”.
“A week is a long time in politics,” is one such overused cliché. The problem with clichés is that they are usually true. Four weeks ago, this column focused on Health Minister Dr James Reilly as a “lucky general”. This was written before Budget 2014 was published.
Within weeks of that column, the Minister was once again in the headlines for his bungling of the budgetary process. It is worth going through the sequence of events.
There were fewer leaks in the lead up to Budget 2014 for a combination of reasons. One was the requirement by Europe for an earlier budget. Another was the timing of the referenda, which distracted much political and media attention from the budget. The third reason was much tighter control executed by the economic management committee, made up of Taoiseach Mr Enda Kenny, Tánaiste Mr Eamon Gilmore, Ministers Mr Michael Noonan and Mr Brendan Howlin, of what was actually in the budget.
It is the responsibility of each minister to negotiate their budget with the minister who has responsibility for public expenditure and reform (Mr Howlin). This process begins months in advance of budget day.
All in the name of greater accountability and transparency, the 2011 Programme for Government commits “the Minister for Health to be responsible for health policy and for implementing this ambitious programme of reform and cost control”. Dr James Reilly, as part of his reform, got rid of the old HSE board, appointed his own officials onto a new board, replaced the HSE boss and appointed a new chief finance officer.
In the weeks before the budget, there was some political embarrassment over yet another overrun by the HSE. HSE figures predicted it would overspend €105 million on services by year end and highlighted how other savings not achieved, such as charging for private patients in public hospitals, could add another €200 million on top of that. Ministers Howlin and Reilly denied this, saying that the HSE was within €1 million of its budget by the end of August. Figures subsequently released prove the HSE right.
This government’s Comprehensive Expenditure Report, published in 2012, detailed how €206 million would be cut from the 2014 health budget. However, what emerged on budget day was cuts totalling €666 million. Crucially, this does not include the potential €2oo million to €300 million overrun and expected €300 million in increased costs brought about by demographics and increased demand. Nor does it include additional money to make and keep services safe.
Interestingly, the 2012 expenditure report details cuts of €610 million for social protection in 2014. On budget day, Minister for Social Protection Ms Joan Burton proudly announced that she was expected to bring in €440 million in cuts, but had negotiated it down to €220 million. So Minister Burton managed to negotiate down, while Minister Reilly lost €400 million.
Included in the health budget cuts is €113 million to be achieved through “medical card probity”. HSE Director General Mr Tony O’Brien immediately distanced himself from this figure on budget day and two days later Minister Reilly admitted this sum and measure was imposed by Minister Howlin’s department.
On the same day, Dr Reilly confessed that he did not know about the removal of tax relief for health insurance until he heard Minister Noonan announce it on budget day. While this measure could easily be defended on the basis of equity, in the current environment of a public health system stretched to the point of collapse and citizens no longer able to afford their health insurance premia, it makes no sense and is another nail in the coffin of Dr Reilly’s plans for universal health insurance.
In the “lucky general” column, I questioned Minister Reilly’s “credibility, his ability and the ability of those around him to pull off his ambitious programme of reform” suggesting it was “implausible, especially in the economic conditions that currently exist”. These sentiments remain. In the days after Budget 2014, the Minister stated that he does not want to stand over the “dismantling of the health system”. It seems to me that he is doing exactly that.
One of the not-so-old protesters outside the Dáil the week after Budget 2014 said she was there because she felt what was happening to the health system was barbaric. She is right. If €1 billion is cut from the health budget in 2014, the implications for every Irish citizen dependent on the health system is barbaric, particularly for the oldest, youngest, sickest and poorest.