Defence of healthcare locations misses mark

ANALYSIS: The reason given for adding locations in the Minister's constituency to a list of primary care centres is problematic on a number of fronts

“TRUST ME, I’m a doctor” is the simplest way of summarising the Minister for Health’s defence of his decision to intervene in the selection of locations for primary care centres to the benefit of two towns in his constituency.

Reilly has a point in highlighting the way some GPs held the health service to ransom before agreeing to join up with other health professionals in primary care centres.

In locations around the country, new facilities were left idle for long periods as haggling continued between the HSE and the doctors, who were needed as the anchor tenants.

The Minister claims that by adding to the list of potential locations identified by officials, he strengthened their hand in negotiations with GPs. The HSE could simply walk away from cases where doctors were playing hardball, knowing they had other options to pursue.

However, this explanation is problematic on a number of fronts.

Last March, due to pressure from the troika, restrictions on the number of GPs allowed to treat medical card holders were lifted. No longer are lucrative medical card lists the preserve of a coterie of doctors – all GPs can now do this work.

Indeed, almost 140 GPs have joined the medical card scheme in the past six months.

Thus, the anti-competitive pressures that once applied have greatly eased, and doctors no longer hold the whip hand in negotiations with the HSE.

But in any case, if this were a genuine factor in considering where to locate primary care centres, why wasn’t it one of the criteria used by officials in their work? And where are the documents outlining how this criterion was to be applied? The Irish Times has asked for this material and it has not been forthcoming.

Reilly was wrong yesterday when he said the original criterion for choosing the locations was deprivation. “As a GP, I understand it’s a lot broader than that. You must take account of health facilities in the area already,” he said.

In fact, the locations were judged on three criteria – levels of deprivation, officials’ assessment of service priorities in an area and the level of accommodation available.

So “health facilities in the area already” had already been taken into account.

In any case, Reilly agreed with his Minister of State Róisín Shortall that “the provision of centres should be informed by needs analysis, with priority given to areas of urban and rural deprivation”.

This decision was minuted.

Shortall subsequently ordered that the weighting attached to deprivation should be increased in compiling the list of locations.

If Reilly felt she was tilting the balance too far, the easiest thing to do would have been to remove this weighting.

The fact is that a process on which the HSE and department officials worked for almost a year, based on criteria approved by the Minister and making use of a widely used and objective measure of deprivation, was derailed at the last moment in circumstances that remain unclear. It’s a long way from the “democratic openness” promised in the programme for government.

Shortall has asked for an explanation from her senior Minister, and she is unlikely to be the only person seeking answers when the Dáil resumes next week.