Kenny should recognise health service failings are ultimately his responsibility
Opinion in Irish Independent on 11 September 2014
Enda Kenny’s remark that he was not interested in endless volumes of explanations on why things can’t get done is fair comment for the leader of government.
One could reasonably expect, three and half years into office, that good progress would have been made on many of the 87 health commitments made in his own Programme for Government.
Mr Kenny’s comments have been interpreted as an unprecedented attack on the newly-anointed health minister – Leo Varadkar. However, a close listening to the Taoiseach can alternatively be heard as a go at the health officials who drafted the briefing, presented in five ‘volumes’, rather than the minister himself.
The volumes, totalling 303 pages, are by no means brief. They are a shoddily put together shopping list of achievements, plans and aspirations for the health sector, with some additional commentary by department officials. There are also some substantial inaccuracies, for example, the very first line says under €1 billion was spent on community drugs schemes in 2013 when, in fact, the figure is €1.8 billion. Whoever authorised putting them in the public domain obviously felt it was in their interest to do so, as well as being a final slap in the face for ex-minister James Reilly.
The main public focus from the not-so-brief documents has been the “unworkable” health reforms proposed by government. In fact, it says the dissolution of the HSE “would lead to a wide range of new statutory organisations. It is the Department’s view that this would be an unworkable construct”.
And they are right. The briefing details the new agencies planned: a Healthcare Commissioning Agency; a Healthcare Pricing Office; a Patient Safety Office, as well as unspecified number of other new hospital, primary, social and mental health care structures.
For a government that came to power with a commitment to get rid of quangos, the plan to set up a whole gamut of new state agencies was harebrained.
And if the Department believed the very plans that they were working on up to July were unworkable, then why did the just-resigned Health Secretary General, Ambrose McLoughlin, not mention this to the Oireachtas Health Committee?
Roisin Shortall’s criticism of the incoherency of James Reilly’s reforms when she resigned as Minister of State at the Department of Health in 2012 have been vindicated but, obviously, the Taoiseach and his government colleagues ignored her concerns.
Interestingly, the document does not say that Universal Health Insurance (UHI) is unworkable, it merely details an enormous body of work that needs to be done before introducing it, including “a major costing exercise” which “is expected to have initial results… early in 2015”.
How any government could have embarked upon such massive reform without a detailed-costing exercise before now is utterly remarkable and stinks of incompetency.
Nothing released into the public domain in the last week tells us anymore than what Mr Varadkar said in the first week of August – that the government has done a U-turn on the three major planks of its health policy. In short, the HSE will not be abolished this year; universal free GP care will not be delivered by 2016; and the plan for Universal Health Insurance has been shelved.
Instead, Mr Varadkar is focussed on delivering free GP care for under six and those over 70 year of age, on the “need to steady the ship”, trying to stymie the continuous rise in the cost of private health insurance and securing an adequate budget for health.
One of the reasons Mr Reilly lost most political capital with his government colleagues was his very public mishandling of the health budget negotiations. Mr Varadkar should be mindful that the Taoiseach and those around him despise these discussions happening in public.
As the Taoiseach gathers his troops for their think-in today, he should consider that ultimately he is responsible for the inadequate budget allocated to health over the last three years and that all major promises made by his government have and will not be delivered by 2016. Whether the Taoiseach likes it or not, many more volumes will be written on this government’s broken promises in health.