Medical card issue left to fester

No one in Government is willing to take the blame for the medical card fiasco but Health Minister James Reilly looks likely to become the fall guy, writes Political Editor Mary Regan.

Medical card issue left to fester

IT WAS a cold October evening when Taoiseach Enda Kenny missed his chance for an encounter that might have forewarned him of the current medical card mess.

As he was driven into a Limerick’s South Court hotel on a Friday evening for his party’s ard fheis, he went past eight-year-old Ronan Woodhouse who has Down Syndrome and was holding up a sign.

“Give us back our medical card, Taoiseach,” he and his mother shouted after waiting outside for two hours to explain the health effects suffered by Ronan since his medical card was removed. Mr Kenny looked straight ahead and the car drove past.

Inside the party conference there was a jubilant atmosphere, with much of the focus on Mr Kenny’s announcement of an impending exit from the bailout.

On the Saturday morning, the party faithful gathered to hear Finance Minister Michael Noonan, who said that people would be “astounded by all the good news” in the Budget due to take place the following Tuesday.

In a contrived panel discussion, chaired by MEP Mairead McGuinness, he was asked if the Budget was 99% done. “Ah, there’s bits and bobs, you know,” he said to laughter and applause.

Those bits and bobs turned out to be not much of a laughing matter. Behind the scenes there was something close to a war being fought between Health Minster James Reilly and Public Expenditure Minister Brendan Howlin over the health budget.

That Sunday evening — 48 hours after he drove past Ronan Woodhouse — the Taoiseach entered Government Buildings. He sat down with the Tánaiste, Eamon Gilmore, and Mr Reilly and Mr Howlin.

The meeting dragged on and with frustration that health figures were not adding up, Mr Reilly was presented with the €113m of savings which should be made through medical card ‘probity’.

The final bits and bobs were in place and, following that health meeting, the Cabinet met to sign off on the final Budget figures just before midnight.

The Labour spin machine immediately came into operation, highlighting its big political coup in securing free GP care for children under six.

With the bailout exit in sight, the Fine Gael side of Cabinet was happy to steady the nerves of its Coalition partner and Joan Burton managed to reduce her social welfare cuts from a planned €440m to an easier to stomach €229m.

Ruairí Quinn, the Education Minister, had to find just half of his anticipated €100m adjustment.

So did Dr Reilly have a point when he told the Fine Gael parliamentary party meeting on Wednesday night that he did not get the support from the Cabinet on the issue, and that the political will to fix the medical card problem only emerged in recent weeks? Or is he merely looking for cover?

In many ways, there was nothing new in his assertion that he did not get the support of his colleagues on the medical card issue and his attempt to shift the blame to Mr Howlin.

Just two days after the Budget announcement, Dr Reilly went into the Oireachtas Health Committee, where he immediately distanced himself from the measure. He said the figure was “allocated” by Mr Howlin based on his “deliberations” of a consultancy report by Price-WaterhouseCooper that said between €60m to €200m could be achieved through identifying waste from ineligible cards.

“That report is from 18 months ago and obviously a lot of action has been taken since then,” Dr Reilly told the committee. “I am — frankly speaking — concerned about what can be achieved here,” he said.

The next day, the Irish Examiner 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.

So essentially, the €113m figure was based on very little or perhaps nothing at all. Mr Howlin has never addressed that issue adequately.

At the time, those around him said privately that they had no choice but to hand the figures to Dr Reilly because they had to go through the health savings line by line and the minister had still not provided a proper outline of savings.

Publicly, Mr Howlin said the €113m figure was “decided by Government”. And he stood over the claim that the savings could be achieved through “removing cards that are no longer in use, cards for people who have died or who have left the country... or people whose circumstances have improved since they applied for the card”.

However, newspaper pages and TDs’ constituency desks were already full with more and more examples of people losing their cards. All the while, senior members of Cabinet and the Taoiseach insisted there was no change to policy, and this was simply a “cleaning-up” exercise.

In early November, Mayo Fine Gael TD John O’Mahony and Galway West Fine Gael TD Sean Kyne told the Dáil about “frightening letters” arriving in people’s doors.

The issue continued to dominate and Ronan’s mum, Noreen Keane, wrote to Mr Kenny later that month, warning that her son’s life was at risk over the removal of his card.

The terminally ill campaigner Marie Fleming — who had taken a Supreme Court “right to die” case — was asked to produce evidence proving her illness. In response, the Taoiseach accepted that more compassion was needed in the process but still nothing changed.

It was not until the start of May — two weeks out from the local and European elections — that Mr Kenny accepted the removal of discretionary medical cards was “an issue” of concern to parents of sick and vulnerable children.

He told the Dáil he was asking the HSE to take a more humane approach when examining cases.

It was a full year after concerns were first raised in the Dáil about how seriously ill people and children with severe disabilities were losing the benefit without warning.

After the election was held, the Government realised it was time to halt the controversial review. And with the fiasco far from over, the blame game is well underway.

Dr Reilly was correct in saying that the Cabinet collectively had responsibility for the medical card review and collectively failed in waking up to the problems it was causing.

But so too was Ms Burton, who told RTÉ’s Sean O’Rourke programme yesterday that — as the line minister — he has to stand over decisions in his Department.

Ultimately, it was a case of Cabinet taking its eye off an issue that was — for so long — staring it in the face. It’s true that Dr Reilly raised the alarm bells that it was not possible to achieve — but he did so without offering alternative cost savings that were enough to satisfy Mr Howlin’s number crunchers.

The upshot for people who have lost their cards is that no one in Government appears willing to take the blame. However, the crisis is now such that Mr Kenny will need a fall guy — and Dr Reilly will most likely take the hit in order to draw a line under the issue.

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