Our Health Minister really does need a break — a very long one

I READ at the weekend that the Minister for Health had spent part of her holidays over Christmas in a luxury hotel in Thailand.

Very nice it looked too.

But to be honest, I don’t begrudge Mary Harney a holiday.

In fact I think she needs one.

And on the assumption that she’s paying her own hotel bill, I couldn’t care less what kind of hotel she stays in.

Why do I think she needs a break?

Because it has been obvious for some time that the pressures of the job are beginning to tell.

Sometimes, in fact, it seems as if the minister is living in a fairytale world all of her own.

Consider this, for example. Shortly before the budget in December, the minister announces that it is her intention to reduce the non-pay elements of the health budget by about a billion euro. The message is clear.

We’re spending too much on healthcare. The country can’t afford it any longer.

In the budget itself, however, the cut is slightly less than the billion forecast by the minister.

In fact, it is three-quarters of a billion. Confirming this on budget day, Harney says: “The health service must, of necessity, contribute to the expenditure reductions required next year. My objective in today’s Health Estimates has been to ensure that these reductions are achieved in a way that minimises the impact on services to patients and continues to protect as far as possible, the most vulnerable. To do this we need to reduce costs and improve productivity.”

Again, the message is pretty clear, isn’t it.

Running the health system, in the minister’s view, is about cutting costs.

In the same budget day announcement, the minister confirms that she is going to squeeze a further €75 million out of increased charges for private and semi-private care in public hospitals.

This, she says, is in line with the government’s policy of not subsidising the treatment of private patients.

She knows, of course, that any increases in private or semi-private care in public hospitals are immediately passed on, in full and pretty well automatically, to the health insurance system.

But she chooses not to say that in her statement.

Instead, having cut three-quarters of a billion out of the health budget, and squeezed €75m in extra charges, she goes on to tell the HSE that it should now go and complete its service plan for 2011.

And she has some advice to offer the HSE while it’s doing so, when she makes it clear that “the minister has asked the HSE not to apply an across the board expenditure reduction.

Instead, there should be somewhat lesser reductions in the budgets for disability and mental health services, and correspondingly greater reductions in the allocations for acute hospital services”.

The message is still crystal clear. Cut, cut, cut. Cut everything.

Cut services for people with disabilities and for people suffering from mental health problems — problems like depression, anxiety, anorexia, and life threatening mental illness as well. Only don’t cut those services quite as much as others.

Cut hospital services more, to give mental health and disability services a bit of a break.

So, within a month or so of the minister cutting huge chunks from the health care budget, and imposing new charges, what happens? Well, three things happen — and you can be fairly certain a fourth thing will happen any day now (maybe even by the time you read this). Let’s deal with them in order.

First, as instructed by the minister, and in line with the budget she has imposed, the HSE completes its service plan and submits it to her for approval.

A couple of days before Christmas, the minister issues a statement approving the plan.

In this new statement the minister says that she “requested the HSE to give favourable treatment to disability and mental health services in the budget setting process”.

And she concludes: “We are asking the health service to deliver at least the same level of services next year with less staff and less money.

This requires improvements in care pathways and also more flexible work practices in line with the Croke Park Agreement.

It is a challenge to everyone working in the health services to focus on delivering the innovation and change required to protect and indeed improve our services for patients.”

And then, as we know, the minister goes on holidays.

She has hardly got over the jet lag from all those long flights before the second thing happens.

The hospitals whose allocation she had insisted be disproportionately cut are inundated by patients, first as a result of the bad weather and then as a result of the swine flu. The consequence? Enormous queues of trolleys, terrible discomfort and indignity for Irish citizens, and hospitals forced to live within strictly and recently imposed stringency budgets.

No contingency plan, no emergency response, no management of risk. And no political accountability or oversight. And then, before the minister can even get her towel into position beside the pool, the third thing happens.

The VHI discovers that effectively, it is going to have to pay the €75m in extra charges for private and semi-private care.

It’s the straw that breaks the camel’s back. The VHI is forced, as a direct consequence of this decision (the largest once-off increase of its kind in history) to abandon its decades-long efforts to run a community-rated health insurance policy.

UP to now, the VHI has been built on the premise that it will spread the risk of health insurance equally across all sections of its customer base.

That has always meant that healthier and younger people pay a little more, so that the insurance of older and sicker people will remain affordable. Under the weight of this new charge, that principle is abandoned, and the VHI is forced to impose massive increases on those who need the most care.

Finally, word reaches the minister beside the gently lapping waves that there is a crisis at home, and that people are being driven mad by the VHI increases.

She instructs the department to issue a statement on her behalf. It encourages people, some of whom have been with the VHI for 40 years, to shop around.

I said four things would happen, and the fourth is as certain as night follows day.

There will be a statement from the minister — perhaps even, on her return, an interview — in which she makes it absolutely clear that she has no responsibility whatever for any of this.

Despite the fact that the crises of the last couple or weeks are the direct consequence of decisions she has presided over and forced through, she will fail to see any reason she should take the blame. That’s why I think there’s no doubt about it. This minister definitely needs a break. A long one.