Fundamental questions remain on Reilly decision
ANALYSIS:A week after The Irish Times revealed that Minister for Health James Reilly had opted to include two locations in his constituency for primary care centres, the Minister has failed to offer a persuasive rationale for his action, writes PAUL CULLEN
THE CENTRAL question that still cries out for an answer is why, when he decided to extend the list of priority locations, Minister for Health James Reilly simply didn’t add the next 15 places from Róisín Shortall’s list.
In the Dáil on Thursday evening, Reilly said this was because Shortall had tripled the value attached to deprivation in assessing the suitability of sites, to the disadvantage of Swords and Balbriggan.
But if this is the case, why didn’t he simply go back to an earlier list in the file – the same file obtained by The Irish Times under freedom of information – and base his selection on that. There are several drafts of the list in the file and a number of early ones were compiled before the weighting was attached to deprivation.
However, these made no difference to the relatively low rankings of the two north Dublin towns in the overall ranking.
Also in the Dáil, Reilly made reference to a 2007 list of primary care centres prepared by the HSE, on which he claimed the two towns ranked prominently. He provided no detail of the number of towns on this list, the position of Swords and Balbriggan on the list and even whether any ranking was applied in the list. This information was being sought at the time of writing.
Another fundamental question relates to documentation underpinning the Minister’s decision. Does this exist? If so, where is it? We have an extensive file in relation to Shortall’s list, with protracted involvement by officials from the HSE and the Department of Health. There appears to be no similar record of Reilly’s decision. All we have are the justifications offered after the controversy broke.
By now, the Minister has given quite a long list of reasons in defence of his decision to add Swords and Balbriggan to the list. These include the need for GP buy-in, the size of the locations, the absence of public transport links to hospitals and high unemployment.
The problem is that these reasons beg questions in relation to other locations among the 15 he added to the list. If size matters, what are Dungloe in Co Donegal and Ballaghaderreen in Co Roscommon doing on the priority list? If unemployment and deprivation matter, what is Westport – best place to live in Ireland – doing there? If distance from hospitals matters, what about Kilkenny, home to the State’s best-performing hospital?
Indeed, why is a new centre planned for Kilkenny when a primary care centre was opened in the city only last year? And when another one was opened by Minister for the Environment Phil Hogan in Callan, 10 miles up the road, earlier this year? Reilly’s extension of the list includes a second proposed centre in Hogan’s constituency, in Tullow, Co Carlow.
Another important question relates to external intervention in the selection process. Who lobbied the Minister about primary care centres? Was he lobbied by other Ministers or TDs? How did this affect the process? Roscommon TD Frank Feighan, under pressure since Denis Naughton left the Fine Gael fold over a local health issue, has acknowledged that he lobbied successfully to have centres built in Ballaghaderreen and Boyle.
The Irish Times first asked Hogan last Sunday whether he had lobbied his Cabinet colleague but has yet to receive an answer to this question.
It is clear the Cabinet approved the list of 35 locations presented by Reilly as part of a Government stimulus announced in July. But how much did they know? Did they know that he had added 15 towns? Did they know the basis for adding same? If so, did they approve of the changes?
In the early days of this controversy, Reilly was able to point to the full involvement of his Cabinet colleagues in the decision, but in recent days Ministers such as Brendan Howlin and Joan Burton have said they didn’t know about the underlying detail.
Finally, the documentation points to the Minister having agreed with Shortall last
February on the deprivation-oriented criteria underlying the selection process. If these agreed criteria were good enough for him then, what happened by July to change his mind?