What Enda Kenny needs from the next health minister
See here my analysis from the Irish Independent on 9 July 2014 – Who ever gets Health portfolio must hit the ground running
What Enda Kenny needs from the new Health Minister is a safe, tough, compassionate, credible pair of hands. At a minimum James Reilly’s successor must score high on the damage limitation front.
Facing the next minister is the insurmountable task of convincing the electorate that the health services are improving, and that his or her plan for reform is the right one. And that needs to be done soon, before the 2016 election. There is a critical window of opportunity for change now; if this is not seized, it makes it much more difficult to instigate change later on.
First on the list of ministerial requirements is credibility. The new minister needs to be reasoned, informed, reassuring but also tough and believable enough to undo the credibility damage done by James Reilly.
A very close second is performing well in the 2015 budgetary process and negotiating an adequate health budget that will not need a supplementary budget in 2015. Taking any more money out of a health system that has already had over €2bn taken of it out will just mean further reductions in medical cards and increased rationing of care – two sure ways to guarantee an even greater hammering in the next election.
This will take significant powers of persuasion to garner the wider cabinet support required to alter the arrogant powers of the money mandarins – the Department of Public Expenditure and Reform.
There are other options to cutting the health budget, such as more cuts to staff pay or raising taxes to adequately fund services needed to meet demand. But neither of these are politically palatable or likely under this regime.
Third is delivery. This Government made promises of reform and then spectacularly failed to deliver. The only way people will now believe in the promises of reform is if they actually see it and live it. Only when citizens can bring their child to the new local primary care centre, visit their GP without charge, have a family member receive a medical card on the basis of medical need, get the home help hours they need or the essential occupational therapy and speech and language therapy for their child with a disability, will the reform be believed.
The fourth task is to maintain the momentum gathered on delivering medical cards on the basis of medical need. The Government was trounced in the elections before eventually seeing the light on this thorny issue. The new minister will have to deliver some medical cards on the basis of medical need before the next election.
The fifth crucial undertaking is improving and ensuring quality of care throughout our health system. Some progress has been made on this but there is a real danger that increased need and demand for care on a system with diminishing resources could well hamper any progress made and cause even more harm.
Michael Kelly, the third last Secretary General in the health department, has suggested about how there should be two secretary generals in health – one to fire fight the persistent crises that emerge in the sickness services and another to do health system planning and reform.
The Taoiseach could do well to apply a version of this concept – why not a junior minister who had full responsibility for improving access and quality of health and social care services and a senior minister responsible for public health and health reform?
Being a real public health minister would require working across all government departments so that a sustained improvement in public health can be achieved. And only if there is a more progressive redistribution of income and wealth will health inequalities be reduced.
The programme of health reform must focus on improving quality and access to care. Having their focus on public health and reform could allow the new minister to move from the inequitable, complex, costly, not so great quality system, to a sustainable one that meets the needs of the whole population.
Reilly’s greatest weakness was his own self-belief that he could deliver his enormous reform programme in the midst of the economic crisis. So preoccupied was he with his reform that he failed to listen to what was happen to citizens. Combined with failure to garner political support for universal health insurance meant his plan was doomed.
If the new Health Minister could singularly focus on delivering some tangible wins early on, there is the possibility of restoring credibility to and faith in our much needed health services. Ignored or unachieved health will guarantee an alternative government by 2016.