Getting a grip on health
Health is an area prone to political controversy in the form of unexpected clinical scandals. For the current administration it has posed an unprecedented range of challenges. From a financial perspective, the unresolved budgetary overrun of hundreds of millions of euro in the Department of Health threatens the Government’s credibility with the EU and the IMF. The Government has now signalled a supplementary health budget will be required to balance the books.
This represents an embarrassing U-turn for the Taoiseach who has vehemently denied a need to provide additional funding for the health budget. And although the final bailout amount will be a fraction of the €13.5 billion annual health funding, failure to gain financial control for at least six months sends the wrong kind of message to the troika.
The unfortunate ability of Minister for Health James Reilly to attract controversy has been demonstrated repeatedly; most recently by his management of the tragic case of Savita Halappanavar. The appointment of three consultants from University Hospital Galway to the seven-person investigation team was inappropriate; that it was not spotted at a political level merely underscores a lack of nous at the top of the Department of Health. The successful appointment of an eminent inquiry chairman was undermined by the unseemly row that followed and the inevitable reversal of the decision to include clinicians from the institution being investigated.
This newspaper has uncovered inconsistencies in the process used to choose the location of primary care centres, a central plank of Government health policy. The saga stretches back to the resignation of junior minister Róisín Shortall, following the alteration of a priority list of locations she had submitted to Dr Reilly, a move she described as “blatant stroke politics”. Her choices were largely based on deprivation considerations. However the Minister for Health added some 15 additional locations, some of which were added just hours before the list was published. Two of the additional locations were in the Minister’s own constituency while others were described as examples of political patronage. The documents do not show the rationale Dr Reilly employed in altering the original list, but the Minister has said he made his decisions based on a number of factors including the likelihood of GP buy-in to the plans. However his Dáil statement in October that his involvement represented “logistical logarithmic progression” has not enhanced his credibility.
Excuses for financial overruns due to “unpredictable” demand-led services will not wash in 2013; health demand can be modelled to allow a more accurate prediction of costs. The Government urgently needs to establish a firm grip on the health arena.