Alison O'Connor: The two lads may have captured the system intended to oversee them
‘What we’re seeing is capture of the reform programme,’ said Róisín Shortall of Paul Reid and Robert Watt, pictured here leaving Wednesday’s Oireachtas health committee meeting. Picture: Sam Boal/RollingNews
Don't worry. The lads have it all sorted out between them. Between the highly paid pair of them, they’ll see us right. Just have a little trust, wait for another few years, all will work out just grand in the end.
After sitting through the Oireachtas committee on health on Wednesday it was difficult not to feel like a bit of a chump; like you were being taken for an eejit. Two men with big jobs in charge of our significantly dysfunctional health services — Department of Health secretary general Robert Watt and HSE CEO Paul Reid — assured TDs and senators all will work out wonderfully well into the future with the transformation of those same health services.
Given, as was pointed out, the pair of them earn over €700,000 between them, you’d think they are certainly well paid enough to do just that. But the really worrying part — which became increasingly obvious as the committee meeting progressed — is that without independent oversight we will simply have to take their word for this.
We’re deep into “pretend” Sláintecare territory now. The way things work around here it’ll be another few years before its spurs are officially hung up. But we all know the drill by now. Fake it ’til you don’t make it.
In July 2019, the Government published a document on that reform. “Working towards universal healthcare for all, Sláintecare reform is creating a health and social care service where people can access the right services, closer to home, and based on need and not ability to pay.”
Ah the innocence of it all.
It’s not to say there will not be changes — and even some good ones. But we may as well say adios now to that central tenet of a health system that is fair to access for everyone.
It is six months since the resignations of the two people who were charged with the implementation of Sláintecare — Laura Magahy, head of the health reform office, and Tom Keane, chairman of its implementation advisory council.
There is no other way of spinning the loss of these two people other than to say it was a hammer blow to the project. Professor Keane, whose reputation precedes him in terms of the success he had with turning around our cancer services, wrote in his letter of resignation to the health minister:
“Sadly, I have come to conclude that the requirements for implementing this unprecedented programme for change are seriously lacking.”
For her part, Laura Magahy said good progress had been made in many important areas, but that “progress had been slow in three key areas requiring dedicated, focused, reform effort: regional health areas; eHealth, and waiting lists”. Pretty blunt in both cases.
Afterwards Health Minister Stephen Donnelly said that neither individual had raised frustrations with him. The first he knew of it was when they resigned.
For so many reasons I’d wager this statement was no great surprise to anyone. These two experienced people knew the way the wind was blowing, not least politically.
Regarding the success of the cancer strategy, Prof Keane has spoken in the past of reassurances he would receive behind the scenes from senior Government figures that they had his back in terms of the agenda he was driving.
Clearly not so this time.
The blunt reality — reinforced by what the TDs and senators heard this week — is that the system has once again reasserted itself and grabbed this critically needed reform agenda to its bosom — where there is a very high risk of suffocation. At best we can hope for a Sláintecare-lite.
The HSE’s Paul Reid said on Wednesday the project is one of the “biggest change processes in the history of the State”. He acknowledged that expertise would be needed to be brought in from outside to assist in that. But what was really clear at the end of it all was this is now to be an inside job.
Back in October there was also a raft of resignations from the Sláintecare implementation advisory council. Mr Donnelly said then this council would be restructured.
But in response to a parliamentary question recently from Aontú leader Peadar Tóibín, Mr Donnelly said responsibility for the implementation of the project “is now devolved to a senior team within my department”.
A new programme board had been established, which reports to him and is chaired by Robert Watt and Paul Reid, as well as senior members of the department’s management board and the HSE’s executive.
On Wednesday the two main players seemed to make a point of back-referencing each other: “as Paul said earlier”, “picking up on Robert’s point”, that sort of thing. But we’ve seen more than enough evidence over the years to know about the fiefdoms that exist and the rush to pass the parcel from one side to the other when a controversy breaks.
Fianna Fáil deputy John Lahart — a Government TD — had the measure of it when he said cynics could be forgiven for believing an independent oversight board had been replaced by the leadership — “yourselves basically” — of the very organisations that were supposed to be subject to scrutiny.
Mr Watt said he and Paul Reid are responsible to the Government for implementation of Sláintecare. This new board structure would be reviewed as time goes on. There was an openness to considering later whether some other oversight body could work. Like that is ever going to happen now.
Poor Róisín Shortall, co-leader of the Social Democrats, the driving force behind it all. She headed up the committee that put together the Sláintecare report. She must have felt like screaming. As she pointed out we’re already halfway through what was meant to be a 10-year major reform programme.
She questioned Robert Watt on the lack of progress on those key regionalisation structures, where real power was to be devolved to the six regions. The HSE is not at all keen on this. Ms Shortall said:
The Government won’t be admitting to this openly, but the Sláintecare towel has been thrown in. Maybe after Covid, this coalition Government, which faces a number of other big challenges, not least on housing and climate change, has decided it’s all too big an ask.
But it is an enormous pity. As Solidarity-PBP TD Gino Kenny said at the meeting, we saw “a glimpse of what could be during the pandemic”. But that’s in the rear view mirror now.
The Dublin Mid-West TD was the first one to raise the issue of the “colossal” salaries being paid to these two men, over €700,000 combined, when “people are waiting years” for healthcare.
Those big bucks certainly do nothing to keep Robert Watt sweet. He seemed to revel in being combative with the elected politicians in this public forum. It’s interesting to contemplate how well that type of personality serves us all in terms of the massive job of work he needs to do on our health services.
The bottom line is don’t hold your breath on Sláintecare.
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