Health – a poison chalice or just bad politics?
Being the Health Minister is no easy task. This week has seen James Reilly in the wars over everything from medical cards to his personal weight. I’ve written a few articles on James Reilly and his performance as minister already and I dont want to go over old ground. As to his personal weight thats a silly irrelevant argument formed by those without even a modicum of knowledge of what politics is about.
So what exactly is the problem here? At a simple biased political level all the problems can be laid at James Reilly’s feet. The reality is however that he is only experiencing the same issues as his predecessors. The only difference being that when he first came to the job Reilly carried quite a lot of hope from many in the profession.
The Department of Health is a mess. It resists reforms and it is made up of several competing agendas. Doctors and Consultants have one view as to how a hospital should be run. However they are not exactly experts when it comes to financials or organisation. A law firm does not make a lawyer the financial controller or the head of HR for instance. Doctors are medical experts but theres more to a health system than medicine unfortunately. The Administrative and financial staff have another view as to what makes a hospital run well but then this often limits the service and the options for patients. The patients have a view of what they want from a health service but it is often at odds with any kind of practical limitation. Nurses have a view and form the backbone of the system but will feel the effects of any systematic change more than most and that’s unavoidable.
At the head of all this you will find a hapless Minister. Each Minister will promise lots while in opposition or in other Departments but when put to the task we are all too accustomed to failure.
From the 1970s to the mid ‘90s the health service was suffering huge cuts, it was underfunded and left lagging behind. As Ireland struggled through recessions successive governments saw it simply as something that the country could not afford to keep running. Minister after minister has talked about ‘value for money’. With the boom came a lot more money that could be invested in the health service.
Despite this the problems have continued. Mind you the numbers put through our health system are impressive and despite all the flak many people find themselves getting excellent care. This is a credit to all the staff of the service.
Ministers during the boom used to bemoan the fact that even though spending increased hugely the results were not as impressive. When the state papers are released from that time I can guarantee you that you will be reading some explosive arguments between Charlie McCreevy and Micheal Martin. Again on a simple political level its easy to say the ministers were rubbish and wasted the money but the problem was of course more complex.
Such was the level of cutting and hardship imposed for 20 years on the service that it had to come from a very low starting point. Money was simply filling gaps and making up for years of chronic underfunding. Imagine spending €30k rebuilding and old car you found in a scrap yard with no engine or wheels and rusting badly. Then imagine spending €30k upgrading a new car. The performance of the new car will of course outstrip the performance of the old. While Ministers complained to those running the service that they were not getting value for money they failed to note that the system was not at the same starting point as other systems.
Can we ever reform health? Yes, its possible. However it is not possible without offending people. To begin with a Minister must be highly regarded and trusted. The minister must accept, however, that that trust will not last long so you need to act incredibly quickly. A minister must accept that they won’t even last to see the reforms through, they can only get things going in an irreversible direction. We need a Minister for Health with a genuine sense of urgency. Highly decisive and not concerned with their popularity. That Minister must start the work and within two years have pushed through the kind of major reforms that cause strikes, controversy and huge change. The Health system moves slowly, so do all the vested interests. Taking them on means you will have to act quickly. They will eventually get you and they will ruin you but a bit like Noel Browne if you do it right you will know that what you started must now continue and though you maybe be cast aside today, you will be remembered for the right reasons many years from now.
We have had several health ministers who have moved too slowly, sought to set up bodies to divert the flak. They have done everything possible to avoid strikes and confrontation with any group. Their careers have always looked beyond their time in the Department of Health.
James Reilly had the potential to be different but he hasn’t turned out that way. In many ways he was well regarded but he was also far too close to many of those involved in the service. He had an idea for a new health system but he wanted to remain popular and not upset former friends. As always happens he has ended up upsetting them anyway without achieving any kind of real reform and hes now two years into the post. If he was forced to resign tomorrow he won’t be remembered as a Noel Browne.
The issue now is that Reilly has let his stock fall while waiting to try and implement real change. He has used up all of his political capital before he ever got started. He now no longer has the trust or the reputation to be able to bring anyone with him. That means when the time comes to face a confrontation and try deliver change his position is already too weak to get a result. Real reform will now only happen after a reshuffle when another minister comes to the post. At that point the new minister will be faced with the choice of real action and long term legacy, or short term career and survival.
Sadly its been many decades since we have had the calibre of politician in any party that saw a two or three year stint as long enough to make things happen and who were happy enough to face the consequences and walk away knowing that in time they might be appreciated for what they did.