WHEN he took on the role of health minister more than three years ago, a confident James Reilly stated that he chose the portfolio because he wanted the challenge of reforming a dysfunctional health service.
“What drove me into politics was health. It is my passion and I believe it is absolutely fixable,” he said. “I would truly love to be the man that leaves a legacy behind him of a fair and equitable health system.”
But that legacy has proven to be as far out of reach for him as it was for Mary Harney, Brian Cowen, Micheál Martin, and all those who went before him.
Now, as he stands of the verge of being moved out of the department, the big question is who is prepared to walk into the land-mine ridden department that has become known as Angola? And can they succeed where all their predecessors have failed by reforming the troubled system which throws up successive scandals over the treatment of patients, is riven by conflicting interests, and delivers massive budget overruns every year?
The new minister will have a number of big challenges:
-Improving its image: In fairness to Reilly, improvements have been made to healthcare, with reductions in rates of cancer and heart disease, as well as a rise in life expectancy above the EU average.
But the system still suffers from a very poor public image, with the people using it or working in it frequently frustrated.
The department and HSE seem to be always on the back foot in dealing with criticism, and the handling of the medical card reviews showed it up as a bureaucratic monster that had lost all human understanding.
Some have suggested that the best any new health minister can do — with only two years left in this Government’s term — is to keep his/her head down, stay out of trouble, and keep health out of the headlines.
-Abolishing the HSE: Reilly has described it as a “monster” and had promised to get rid of it by 2014. The clock is ticking.
The original concept of the HSE when it was set up in 2005 was a good one, with the objective of not only eliminating bureaucracy, but ending the parochial and politically influenced element associated with the old-style health boards.
But thanks mainly to the decision not to impose any redundancies during the changeover to the new system, the HSE was and has always remained top-heavy with administrators.
A big failure when it was set up was missing the opportunity to streamline services. Central to a lot of criticism levelled against it has been that it’s too much about paperwork and not enough about medicine.
-Keeping within budget: Since the onset of the economic crisis, more than €1bn net has been cut from the health budget — and up to €3bn cut, if our growing, ageing population, with an increasing burden of disease is accounted for. Reilly has struggled to manage the service with these ever-shrinking resources, and the HSE has repeatedly failed to meet its budgets, requiring a bailout towards the end of the year to keep hospital doors open.
In 2012, it went over budget to the tune of €500m: in 2013, it overspent by €350m requiring a €200m bailout and €150m of extra savings. It is on course to run to €500m this year — something any new minister will immediately have to get a handle on.
Reilly was blamed for failing to identify savings ahead of last October’s budget, resulting in Public Expenditure Minister Brendan Howlin imposing cuts of €666m to his department, including an initial €113m through medical card probity.
The negotiation of the health budget this year is going to have to be a whole lot smoother.
-Rolling out universal healthcare: Free GP care for children under six — announced in last October’s budget — has been pushed out to the autumn. And with time running out, extending it to all the population before the next general election — costing €400m per year — will be difficult to achieve.
The programme for government committed to free GP care for those on the long-term illness scheme by March 2012, and to those on the hi-tech drug scheme by March 2013; neither was delivered.
The key promise of free GP care for all by 2016 now looks unlikely to be delivered on.
-Cleaning up the medical card mess: Reilly apologised last month for the distress caused to thousands of people who had undergone medical card reviews and promised to restore discretionary cards to 12,000 people — who have been receiving them in recent weeks.
Legislation planned for the autumn to change the medical card system and allocate the benefit on medical needs is likely to be fraught with difficulty.
Certain groups will inevitably feel aggrieved if their conditions or illnesses are not on the list. The department might meet similar legal obstacles to those that got in the way of plans to provide free GP care for people with long-term illnesses.
And the new minister will still have to find the money to pay for an expanded system. Meanwhile, TDs are still hearing cases of people who fall ill or babies being born with certain conditions who are being refused cards. The issue is not likely to go away.
So who is the right person to take on this task and navigate their way through the many land mines in Angola?
ine Gael TDs, who have long been complaining about the management of the health service, say they want to see an innovative minister who can think outside the box and is not afraid of taking on vested interests.
To many, this sounds like a challenge for Leo Varadkar, himself a qualified doctor and seen as a young, dynamic politician who tackles issues head on.
Some believe that a strategic thinker, who will be able to clean up the budgetary mess and stay out of controversy, is what is required — someone like, for example, Richard Bruton.
One thing that most are certain of is that the service cannot take any further cuts and should be saved the brunt of the remaining budgetary adjustments over the next two years.
One suggestion is that the only possible way to save the health service is to call a political “truce” — a sort of Tallaght Strategy for health so that both government and opposition can work together to solve its problems with a long-term plan, spanning government terms. But this seems as idealistic as Reilly’s pledge to turn Angola into East Anglia: “Calm, predictable, and a nice place to be.”
At the last election, the Taoiseach said the public should judge his Government on the fulfilment of its contract to “deliver health services that work, safer streets, and accountability in public spending”.
Along with job creation and fixing the economy, reforms of health will be one of the benchmarks on which voters judge the coalitions success come the 2016 election.
And picking the right person to fulfil this promise might just be one of the most important decisions Enda Kenny will have to make.<
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