Managing the health system
THE DECISION by HSE chief executive Cathal Magee to “pass” on a job that offered a great deal of responsibility but little real power, should not have caused surprise. Yet it was treated as a bolt from the blue. On the one hand, it was presented as a severe setback for Government plans to restructure the health services; on the other, it was taken as evidence that Mr Magee had been ousted by “volatile” Minister for Health James Reilly. Having it both ways has never been a problem for Irish politicians. The incident does, however, draw attention to poor financial management within the HSE; to serious legislative delays at the Department of Health and to the need for Dr Reilly to liaise with ministerial colleagues and provide a precise timetable for reforms.
Dr Reilly may feel his personal financial difficulties have been a major contributory factor to a recent spate of negative publicity. He would be wrong. As Minister for Health he has responsibility for ending a deeply inequitable two-tier health system and replacing it with universal health insurance. That process will involve confrontation with consultants, other medical professionals and various vested interests. It will also require a shake-up at the Department of Health where legislative initiatives, designed to raise urgently needed funding and advance the reform agenda, have been seriously delayed.
Difficulties will not be confined to administrative change, if an end-of-term meeting involving Fine Gael backbenchers is any guide. Any attempt to legislate for the Supreme Court judgment in the X case or for a subsequent ruling by the European Court of Human Rights is likely to bring resistance, if not outright rebellion. TDs and Senators insisted they would have to be consulted about recommendations from an expert group – established under the programme for government – before they went to Cabinet for consideration. They were strongly opposed to a liberal approach. The meeting has offered more fodder for inter-party friction.
Dr Reilly’s tendency to engage in unilateral negotiations and to keep his Ministers of State out of the loop, generated tensions earlier this year. They resurfaced when he failed to advise Labour Party colleagues about Mr Magee’s decision. Such behaviour may seem of little consequence. But, if reforms are to work smoothly, their introduction will have to be agreed and co-ordinated within both Government parties. That applies to contentious health issues as much as to legislation involving abortion or same-sex marriages. An IMF proposal to means-test health entitlements may be equally fraught.
The reform schedule is running at least six months late. Legislation that was to provide funding for the health budget is awaited. Directors who were to take responsibility for the purchase and provision of services have not been appointed. Spending by the HSE may overrun by €500 million. The Minister has published legislation taking control of the health budget and allowing him to direct the HSE in specific areas. It is a step forward. But it will not take effect until the autumn.