Captaining the Titanic a more appealing option than Health

Those bubbles might once have been sound bites, now they are the foam formed by a minister gulping for air, writes Gerard Howlin

Captaining the Titanic a more appealing option than Health

Words and meaning have parted company in the CervicalCheck scandal. Tony O’Brien, the outgoing director general of the HSE, rescues the situation slightly. For as many days more as he remains in place, he provides a target for ire.

Having something to fire towards is politically essential. The fact that he bears part of the responsibility makes his casting as the leading man apparently credible.

But it’s for a purpose. Castigating him relieves the opposition of the burden of having to take out Simon Harris and probably bringing down the Government.

It allows the Government push back responsibility for a deeper systems failure in the organisation of the health service, which is the responsibility of the Department of Health politically.

For all concerned, it allows this row be conducted well back from the brink. Have no doubt, regardless of the tactics, this is the shared strategy.

The alternative is less unspeakable than unknown. No election campaign could carry the complexities of interlayered organisations, and patterns of responsibilities through three weeks.

We last had a new blueprint for the health service feature as an election issue in 2011. Then Fine Gael and James Reilly promised as part of their five point plan that they would “create a completely new, fairer, more efficient health system”.

Simon Harris and Tony O'Brien.
Simon Harris and Tony O'Brien.

The party manifesto said: “Fine Gael’s health plan, FairCare, represents the most ambitious plan for health service reform since the establishment of the State. It is designed to reduce costs, increase access and make the system much fairer.

"It will dismantle the dysfunctional Health Service Executive (HSE) that was created by Micheál Martin in 2004, and end the efforts of Fianna Fáil and Mary Harney to privatise the health system by favouring private over public care.

Our ultimate goal is to establish a system of Universal Health Insurance (UHI), based on the very efficient Dutch model — but adapted to Irish circumstances. The underlying philosophy is that the patient should be treated at the lowest level of complexity that is safe, timely and efficient.

I am teasing of course. There are circles in which it is bad manners to read other people’s manifestos back to them. What happens in an election campaign, stays on campaign.

It does illustrate a point, however. There isn’t an alternative plan on health in sight. Fine Gael abandoned theirs. If it was dead in the water before James Reilly left in 2014, his replacement Leo Varadkar promptly acted as undertaker and buried it.

Simon Harris is in survival mode. There is no plan, and that’s official policy, so this leaves incremental adjustment as a substitute for strategy. Don’t underestimate the energy it takes to tread water.

Those bubbles might once have been sound bites, now they are the foam formed by a minister gulping for air.

Fianna Fáil on health has been weak and uninspired. Multiple crises failed to shake its political leathery. Missed opportunities abounded. It is early days, but there is also a pressing deadline for their new spokesman, Stephen Donnelly.

It is not enough to have something on paper in time for an election, it has to be credible and it has to air to get traction. I don’t think there will be an election this year but turning substantial absence from the health debate into leadership within months is a tall order.

Stephen Donnelly.
Stephen Donnelly.

Sinn Féin is certainly more present. However, it is hardly more discerning. Its spokeswoman, Louise O’Reilly, has acted as lobbyist-in-chief for the trade union agenda - an accusation she probably rates as a compliment.

Sinn Féin on health is about shovelling money into the pockets of the vested interests most culpable for the malformation of an appalling system. For all its difference in tone, it is sweetening those whose support it seeks.

It shares with Fianna Fáil an ironclad assessment that the best time for an election is not yet. Thence the focus on O’Brien. It is agro that stops short of action. It is politics that refuses to gaze into the abyss of policy.

Yesterday as the HSE chief temporarily slipped the noose of a no-confidence motion, I rummaged for George Orwell’s A Hanging and there is the description of warders bringing a prisoner to the scaffold:

It was like men handling a fish which is still alive and may jump back into the water.

They’ll fish him again out soon enough.

The focus on O’Brien, the better to avoid the consequences of responsibility is now established pattern. The comparison is trivial but Denis Naughten is a precedent.

It was immediately clear from Fianna Fáil and Sinn Féin that a furore notwithstanding, there would be no scaffold for him. Naughten and Harris as minister-in-crisis took turns to wear the No. 58 jersey.

That is the most important position on the field. It is exactly the number the Government must muster to satisfy the requirement of the confidence-and-supply arrangement, that it have a majority of one over all others in a Dáil vote where Fianna Fáil abstains.

Taking out No. 58 is blowing the final whistle. So forget about accountability. Focus on keeping the show on the road.

Yesterday,Fergus Finlay pointed out that “the next CEO of the HSE will be appointed, as things stand, by the Department of Health. Not by the independent board of the HSE, because there isn’t one”.

In a move back to the future Harris has promised to reinstate a HSE board that Reilly abolished.

Unbelievably a department responsible for the dysfunction in accountability that CervicalCheck is a symptom of will preside over the appointment of a new HSE CEO. That’s just the process.

More substantively, years later there is no new GP contract in place. That’s a wholly owned responsibility of a Department of Health which depends on O’Brien to deflect from them.

Resolution of underlying policy and structural issues is a critical backdrop to the job description of the next CEO. Captaining the Titanic would be more attractive now.

There is an alternative. The ultimate punishment could be inflicted on O’Brien who would be asked to stay for another year and forced to personally fix CervicalCheck.

The minister would translate his anger into action; set a deadline of Christmas for a GP contact, or face the gallows.

Fundamentally there should be a root-and-branch reform of the Ministers and Secretaries legislation to attack at close quarters the ultimate issues of accountability in Health, which begin in the department. But, rest. None of this will happen.

In Ireland as after Orwell’s Hanging “an enormous relief had come upon us now that the job was done... ‘All has passed off with the utmost satisfactoriness. It was all finished — flick! like that.

It is not always so — oah, no! I have known cases where the doctor was obliged to go beneath the gallows and pull the prisoner’s legs to ensure decease. Most disagreeable!’.”

More in this section

Puzzles logo
IE-logo

Puzzles hub

Visit our brain gym where you will find simple and cryptic crosswords, sudoku puzzles and much more. Updated at midnight every day. PS ... We would love to hear your feedback on the section right HERE.

logo podcast

War of Independence Podcast

A special four-part series hosted by Mick Clifford

Available on
www.irishexaminer.com/podcasts

IE logo

Commemorating 100 years since the War of Independence

Lunchtime
News Wrap

A lunchtime summary of content highlights on the Irish Examiner website. Delivered at 1pm each day.

Sign up
Revoiced
Newsletter

Our Covid-free newsletter brings together some of the best bits from irishexaminer.com, as chosen by our editor, direct to your inbox every Monday.

Sign up