The lucky general
Minister James Reilly has shown remarkable political resilience in the face of questionable achievements to date. My Medical Independent column from 10 October 2013. This time last year Mr Alex White had just been appointed to the Department of Health as Minister of State with Responsibility for Primary Care. Minister for Health, Dr James Reilly was still very bruised and battered after a long summer of exposure of his own problematic financial circumstances as well as the most public of showdowns with his former junior minister Ms Róisín Shortall.
He weathered the storm. She did not. Ms Shortall resigned on a point of principle and subsequently revealed it was not just his “stroke politics” and political interference in the location of primary care centres, but also his constant undermining of her role and policy endeavours that pushed her out of Hawkins House.
A year later, Dr Reilly is still firmly in post while Ms Shortall is silenced on the backbench. Some things have improved for Minister Reilly. The HSE is currently only €63 million over budget, compared to €150 million a year ago. He successfully assisted the Government in getting the extraordinarily tricky Protection of Life During Pregnancy Bill through the Dáil. He still ranks high in political capital with his leader, Taoiseach Enda Kenny. He is no longer in the headlines every second day after another enormous gaffe.
During the third week of September, Minister Reilly gave his longest interview to date to the Today with Sean O’Rourke show. He put up a robust performance; they both did. Minister Reilly blustered through with his usual style, yet he came across as convincing and convicted, even if much of what was said is debatable. He did a good bit of massaging on waiting times for elective care, as is his form, as well as denying a HSE budgetary overrun when the bottom line very clearly shows an overspend.
Towards the end of the interview, Mr O’Rourke got to the nub of Dr Reilly’s Achilles heel – his credibility. He put it to him that one of the issues on which the Minister had campaigned for power and the office of the health minister was the abolition of prescription charges for medical cards. In opposition, Dr Reilly often correctly cited evidence that charges for prescription drugs deter as much necessary as unnecessary use. Yet within months of being in office, he increased charges from 50 cent (capped at €10 per family per month) to €1.50 per item (capped at €20 per family per month) for medical card holders, while those without medical cards now pay €144 a month, compared to the pre-election price of €120.
Dr Reilly deftly admitted his u-turn on this issue, using cabinet decisions and Government choices as his excuse, as he did with many issues in the interview. This administration promised and failed to deliver free GP care for people on long-term illness and the high-tech drug scheme by March 2012 and 2013 respectively.
The Government is now flagging the introduction of free GP care for under-fives and for all by 2016, without any detailed costings. They have not even approached GPs about ensuring this will happen. Similarly, the Programme for Government promised to reduce the cost of care, yet everybody is experiencing more and higher costs to access basic healthcare.
The Minister’s promise for universal health insurance was based on the idea that no one would pay over the odds. However, private health insurance premia rose by 22 per cent in 2011 and a further 16 per cent in 2012. After two and a half years as Minister, Dr Reilly was unable to provide figures on what universal health insurance will cost, in particular what it will cost those who currently have no health insurance or medical cards. How could he? There is no economist in the Department of Health.
While Reilly may be a lucky general, those around him tend not to have a long shelf life. In his first 18 months in office he disbanded the old HSE board and put a piecemeal one in place. He appointed a new secretary general and CEO. Early on, he also appointed a bunch of overpaid advisors, most of whom are now gone. His policy advisors Ms Maureen Windle and Mr Sean Faughnan are gone. Dr Martin Connor, who was whisked in from the UK, via Stanford University, to lead the Minister’s Special Delivery Unit disappeared from the post not halfway through his contract. A new advisor Camille Loftus is in place – a curious appointment given her expertise is in social welfare policy.
There is no questioning Dr Reilly’s zeal or intent. However, it is his credibility, his ability and the abilty of those around him to pull off his ambitious programme of reform that is implausible, especially in the economic conditions that currently exist.