Knives drawn in battle over health reform

Róisín Shortall laid the blame bluntly at James Reilly’s door, says Political Editor Paul O’Brien

TENSIONS between senior and junior ministers at a department are nothing new.

Fianna Fáil’s Padraig Flynn, when senior minister at the Department of the Environment, famously insisted that junior minister Mary Harney use a different entrance to him.

But it’s rare enough to get a junior minister openly attacking his or her senior colleague in the Dáil.

Róisín Shortall may not have mentioned James Reilly by name in her speech on Wednesday night. But it was crystal clear to everyone present exactly whom she was talking about.

In raising questions about the direction of health policy and the lack of reform to date, she was essentially pointing the finger at the health minister.

This during a debate on a motion of no-confidence in Dr Reilly tabled by Fianna Fáil.

Ms Shortall did more to make the case against Dr Reilly than anybody in Fianna Fáil or the rest of the opposition.

The Government tabled its own counter-motion of confidence in Dr Reilly, and Ms Shortall did vote in support of that motion at the end of the debate.

But that was hardly surprising, given she would almost certainly have lost her ministerial job and the Labour whip had she done otherwise, and had already made her real views known.

Ms Shortall is one of two Labour junior ministers at the department, the other being Kathleen Lynch.

Ms Lynch declared full confidence in Dr Reilly during the debate, even though colleagues believe she has nothing of the sort.

Tánaiste and Labour leader Eamon Gilmore also launched a staunch defence of Dr Reilly.

Ms Shortall did no such thing. Instead, in a speech laced with insinuation, she suggested that after 18 months in government, the Coalition still had no “clear roadmap” to end the “uncertainty” about the future direction of the health service. “Are we going to reform and strengthen our public health service or are we going to privatise large parts of it?”

The implication was clear. Earlier in her speech, she had dealt with specifics, particularly on primary care, for which she has responsibility.

“Reform means reducing costs and changing the model of care to switch the focus from acute hospitals to community and primary care. This will ensure early diagnosis, much better health outcomes and much better value for money.”

But while the Programme for Government prioritised primary care, and funding had technically been allocated this year for 300 additional frontline primary care staff such as public health nurses, the money had not yet been released.

“Thousands of people, children and adults, are on waiting lists for these services. It’s time we started the recruitment,” she said bluntly.

In the same vein, she warned that “decisions on where staff are allocated and where primary care centres are located must be transparent and objective, based on health need and no other consideration.”

And so on.

In much of this, Ms Shortall was voicing not alone her own anger, but that of the Labour leadership with Dr Reilly’s performance to date.

It is known that the party leadership has been dismayed for some time with Dr Reilly, and if Eamon Gilmore was being honest, he probably wouldn’t disagree with much of what Ms Shortall said.

But of course, Mr Gilmore is not going to say such things publicly — at least not yet — and party sources believe he would probably have preferred had Ms Shortall not done so either.

One source said the leadership would prefer if such battles were dealt with in private.

“She didn’t do herself any favours,” the person said, pointing to the difference between the comments of Ms Shortall and Ms Lynch and wondering aloud who would find it easier to get their way in the department in the future as a result.

But the real question may now be whether the Coalition can actually continue to allow Ms Shortall and Dr Reilly to work together when their working relationship is close to non-existent.

Meanwhile, for all the criticism of Dr Reilly coming publicly and privately from Labour’s direction, he could be forgiven for swinging back and charging the party of hypocrisy.

Public Expenditure Minister Brendan Howlin wants Dr Reilly to cut hundreds of millions from the health budget in December. And he and his Labour colleagues want this to be done without touching Croke Park or reducing frontline services.

At this remove, it seems a hugely unrealistic request. And for all that Labour is heaping pressure on Dr Reilly, it’s worth remembering Mr Howlin himself failed to match words with action this week.

He was supposed to deliver €75m of savings from public service allowances. He has now decided to leave all but one of the allowances untouched for existing staff. As a result, just €3.5m will be saved this year.

The failings, it seems, are not confined to the Department of Health.