Crunch time for Reilly and over-budget health service By Paul O’Brien

JAMES Reilly is starting early.

Under pressure professionally and personally, he has written to Fine Gael members this week about the forthcoming budget and its implications for the health services. The next few months, he warns starkly, will be “crunch time”.

August is usually when politicians go on holidays and keep a low profile. Cabinet meetings and the Dáil won’t resume until next month. But Dr Reilly, possibly stung by the flak he took during last year’s budget process, seems to be taking no chances this time round.

Rather than await and then respond to the “tight political and media scrutiny” he says will occur in the coming weeks when political activity increases, he is making sure he has his say first. In the process, he is hoping to steel Fine Gael members for what lies ahead and effectively pleading with them to back him.

It shouldn’t come as much surprise.

Last year, Dr Reilly, facing his first budget as a minister, handled the process badly. In the run-up to the budget, he briefed Government TDs about the “nuclear options” he would have to take if forced to slash too much, too quickly from the health service budget.

From the outside, it appeared an attempt to get the TDs to lobby Finance Minister Michael Noonan and Public Expenditure Minister Brendan Howlin on his behalf. To some of his fellow ministers it appeared amateurish, as Dr Reilly’s list of “nuclear options” was immediately leaked by TDs to the press. Those TDs were acting with good intentions — they believed Dr Reilly’s argument about the perils of “frontloading” cuts, and were trying to resist such frontloading — but the stories made the Government look bad.

A €50 charge on medical card holders was, for example, one of the nuclear options floated. Even though it never materialised in the budget (and, realistically, was never going to materialise), it gave the public the impression that the Government would pick the pockets of the vulnerable in every way they could.

Since the budget, things haven’t gone much smoother for the minister. The HSE is running massively over budget, with concerns that the deficit could reach €500m by year’s end. Fianna Fáil leader Micheál Martin has accused the Government of providing “false and dishonest” estimates for the health services last December. Taoiseach Enda Kenny, meanwhile, has ruled out any “supplementary estimate” — or additional funding — meaning that the deficit will simply have to be closed by cutbacks and savings. Coalition partners Labour are unhappy with the manner in which Dr Reilly is going about making these savings — rather than reducing consultants’ pay, as had been promised, he is targeting overtime and sick leave, among other things.

A separate row broke out over Dr Reilly’s failure to provide advance notice to Labour of Cathal Magee’s planned resignation as HSE chief executive. Tánaiste and Labour leader Eamon Gilmore first learned of it from media reports. It led to Mr Gilmore making his displeasure with Dr Reilly known publicly.

And then, of course, there was Dr Reilly’s personal difficulty — being registered as a debt defaulter in Stubbs Gazette, with a €1.9m judgment registered against him and four fellow investors in a Tipperary nursing home.

Dr Reilly has pledged that the money will be paid, and that he has at all times acted with complete propriety, but until the debt is cleared it will remain a political, as well as a personal, problem.

Given all of the above, it is easy to see why Dr Reilly, in the eyes of some in Leinster House, is viewed as the most vulnerable minister. The fact that he is deputy leader of Fine Gael and a staunch ally of Mr Kenny are two of the few things going in his favour. While no minister could be expected to turn around the health service in 18 months, he has attracted more criticism of his performance than most other ministers.

It is, one suspects, this sense of vulnerability that is prompting him to act so early. Dr Reilly’s letter paints a picture of significant progress being made despite the many obstacles. He details, for example, how there has been extra demand for services this year, ranging from an increase in hospital admissions through emergency departments to 125,000 more medical cards. “We’re clearly doing more. But we’re also doing better,” he writes, adding that there were 10,000 fewer people on trolleys in emer-gency departments in the first half of this year compared to last year.

“That’s important and real progress — we can find no comparable improvement in any similar healthcare system anywhere in the world.”

But the key parts of the letter are where Dr Reilly details what lies ahead.

“This year, we’ve to find savings of around €700m in our health services — massively difficult at any time, but much more so because of the increase in activity.”

He makes clear that he is sticking to his plan to find savings by targeting excessive sick-leave, overtime, and use of agency staff in the first instance. “I can make only one promise to you as a member of the Fine Gael party: We’ll put patients first and we’ll put reduction in services last.”

Sceptics may wonder how realistic that promise is — taking another €700m out of the health budget without reducing services would be close to a miraculous feat. But all that detail remains to be finalised. The true purpose of the letter, one suspects, comes in the final paragraphs:

“Over the next weeks you will hear opposition voices predicting calamity and catastrophe in the health services. The same voices were at work earlier in the year predicting the same doom and gloom in the context of the high level of staff leaving the health services through early retirement. But remember, they weren’t right then and they won’t be right now either.

“I’m grateful for your support in meeting the serious challenges that lie ahead. Fine Gael as a party has never shied away from facing challenges in the public good. And remember, the greater the challenge, the greater the opportunity to give our people the health service they need and deserve.”

It’s partly a rallying call, partly an appeal for support. James Reilly will need it in the coming months.