Health could make or break Leo

See below for column on how health could make or break Leo Varadkar, from the Irish Independent on 12 July 2014.

It should be no surprise to Leo Varadkar that he is the new Minister for Health, sure Paddy Power had him at the shortest odds for the health post for months.

 

It was inevitable that Enda Kenny would have to shift James Reilly out of Health as he bungled his way through his time in Hawkins House. And no better way to slow down the march of a young man in a hurry than hand him the mantle of the Health ministry.

Varadkar must make sure to cause no more trouble for government in Health between now and the next election. No easy task, especially for someone who does not mince his words. Known for his straight talking and not towing the party line, this might well help Varadkar over his first essential hurdle – to come out the better of the Department of Public Expenditure and Reform in Budget 2015 negotiations.

James Reilly as minister, failed to win crucial support on the health budget from his own cabinet colleagues. Varadkar will have to show more political nous and win over Cabinet and his own party members on the all-powerful Economic Monetary Council. Despite his medical training and early, but, short time as a hospital doctor and then a GP, we know very little about where the new Health Minister stands on health policy matters. Does he agree with the party line of universal access to care on the basis of need, is he too an evangelist of Universal Health Insurance and free GP care for all? Not known for his radicalism to date, it will be interesting to see where Leo sits on the universalist fence. Given the government announcement this week to give free GP care to all over 70-year-olds, including the richest, as part of a renewed Programme for Government, this will be a good first test of his ideological stance in health policy.

His ideology will also be tested on whether he delivers on medical cards on the basis of medical need between now and the next election. Critical for government is that Varadkar must succeed where Reilly failed – which is to live up to their own profession’s Hippocratic Oath – to do no harm – or at least to do no more harm. James Reilly’s fatal blow in the Health ministry was taking away discretionary medical cards from some of the sickest and most disabled.

Reilly was so preoccupied with his enormous and often chaotic programme of reform that he failed to listen to what was actually happening to citizens. This combined with failure to garner political support for universal health insurance meant his plan was doomed from the onset.

Moving him sideway, instead of out of Cabinet, shows how much the Taoiseach still values Reilly’s support during the 2010 heave. Reilly has always said he entered politics with the singular aim of being Health Minister, so being moved to Children and Youth Affairs is a political blow to Reilly and move downwards in terms of cabinet pecking order. But it shows his political ambition and stamina and was the one way that Enda’s henchman could save some face, especially given his new public health remit. Plus, it’s a definite improvement on Foreign Affairs from Reilly’s perspective.

While Reilly was high on the rhetoric of reform, he failed to deliver critical health service advances and promises of health reform. Children’s services have been much ignored for decades in Ireland. They need a steady, surefooted minister who will secure them an adequate budget and oversee their transformation. Reilly’s track record in Health does not bode well for much-needed reform of children’s services.

In Health, Reilly was rightly credited with taking on the tobacco industry and overseeing Ireland’s first ever public health policy – Healthy Ireland. If Reilly manages to begin the implementation of Healthy Ireland, by gaining the political and cross-sectoral support it needs, then he could do much more for children’s health and well-being than any other public policy initiative and salvage his own political reputation.

Varadkar will be tested in the months and years ahead. Can he avoid the landmines of Hawkins House, primarily by doing no further damage on the medical card front? Can he override the hawks in Public Expenditure and secure a sufficient health budget for 2015 and 2016, crucially avoiding any more supplementary budgets? Can he drive the quality and care agenda and not politicise health policy decisions? Securing a critical few wins in Health in the near future must be Leo’s survival strategy. Only when citizens and families experience improvements in the health services can the credibility of the health ministry be restored.

The Department of Health may well make or break Leo’s political ambitions. By giving Varadkar the Health ministry Enda Kenny is seriously testing whether Varadkar is a politician of substance and a Taoiseach in the making.

 

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