WORRYING DIAGNOSIS

THE health service is facing a year of chaos as thousands of people fear they will lose their medical cards, and the Government has no idea how it will be managed.

But calls for Health Minister James Reilly to resign are a distraction from the truth about what is happening in the health service and how the Government is deciding on cuts to the most essential of public services.

Last Friday, the Irish Examiner reported that both the HSE and the Government were planning separate “validation” exercises of the figures provided for health cuts next year.

At a meeting of the Oireachtas health committee on Thursday, both Dr Reilly and the head of the HSE, Tony O’Brien, distanced themselves from the decision to cut €113m from the medical card scheme through a “probity” exercise.

The figure in question translates to a cull of between 100,000 and 150,000 medical cards next year. But mystery still surrounds its origins.

Mr O’Brien rightly pointed out that the Government cannot unilaterally change the eligibility for medical cards or alter people’s statutory entitlements, so if such savings could not “reasonably” be found through probity, then cuts must be found elsewhere.

“We saw the need for an objective verification process,” he told the committee when asked about the €113m in savings, adding that there would be a ” thorough assessment” of whether this could be achieved.

This, he said, will feed into a separate validation exercise being carried out by the departments of the Taoiseach and Public Expenditure, which Dr Reilly requested because he was “frankly concerned about what can be achieved here”.

Dr Reilly said the €113m figure was decided by Public Expenditure Minister Brendan Howlin, based on his “deliberations” of a report on medical cards by PriceWaterhouse-Coopers.

Dr Reilly pointed out that the report — suggesting savings of somewhere between €60m and €200m — was published 18 months ago and “obviously there has been a lot of action since then”.

On Friday, the Irish Examiner also reported that the authors of that PwC study had included a disclaimer that the projected figures were “indicative only and cannot be relied on for any purpose other than providing a broad understanding” of the issue.

A HSE spokeswoman at the time told this newspaper that because of the small number of cases reviewed and the lack of a database audit, the 52-page report’s suggestion that such a large amount of money could be saved was not entirely accurate.

“Given the short time in which this part of the work was conducted it cannot be relied on for any purpose other than providing a broad understanding of the potential scale of the problem,” she said.

The health minister and the health service all have concerns about the veracity of the €113m figure, if it can be achieved, and what the consequences of it would be.

And there is an unprecedented situation where a sum of the magnitude of more than €100m is announced in the budget, with a validation exercise of whether it can be achieved being carried out afterwards.

Yet nobody is taking responsibility. Dr Reilly said the figures were imposed on him by Mr Howlin, whose spokesperson said last night they “were decided by Government”.

This newspaper submitted questions to Mr Howlin’s spokesperson on Friday. After close of business last night, they came back with a response saying the figure was arrived at by Government “having regard to the findings” of the PwC report. They said a review of all medical and GP cards will now be carried out “to remove ineligible and redundant cards”.

The spokesperson wrote: “This will include removing cards that are no longer in use, cards for people who have died or who have left the country and who have not been removed from GP panels, and reviewing the entitlement to cards of people whose circumstances have improved since they applied for the card.”

But they failed to address suggestions from Dr Reilly, the HSE, and doctors themselves that this level of waste does not exist in the system, and that such savings are highly questionable.

Asked about Mr Howlin’s views on the HSE decision to carry out a validation exercise before including it in his service plan for 2014, they said: “It is a matter for the HSE to produce a service plan consistent with the Government’s decision on its estimates.”

Opposition parties claim Dr Reilly has lost control of his department’s spending, because the Taoiseach and public expenditure minister have been called in to keep an eye on figures.

Some of Dr Reilly’s own Fine Gael colleagues say he is merely looking for political cover so that he can share the responsibility when the health service finds it can’t live within budget next year. But Dr Reilly’s side argue that the figure was imposed on him at the last minute, and he believed it needed to be verified.

A scheduled monthly meeting of the cabinet sub-committee on health took place last night, bringing together Dr Reilly, Mr Howlin, Frances Fitzgerald, and the Taoiseach.

A post-budget row is continuing over Mr Howlin’s imperative to protect the Haddington Road Agreement as well as the Labour Party’s demand to keep welfare payments low — versus Dr Reilly’s claim that the health service has now been cut the bone.

For Enda Kenny, it came down to a choice between sticking by his loyal colleague and deputy leader of his party, or keeping stability with his coalition partners.

Labour won out in the budget discussions but the battle over health spending is far from over.