Government parties showing a steely determination to punish their enemies

Opinion: Timing of publication of HSE report on top-ups suggests attempt to deflect attention from further cuts

Dr James Reilly: on the back foot after a disastrous outcome for his department in the budget. Photograph: Cyril Byrne

Dr James Reilly: on the back foot after a disastrous outcome for his department in the budget. Photograph: Cyril Byrne


They are not the first government to practise the “that will learn you” strategy of political defence but Fine Gael and Labour Ministers and their spin doctors have proved particularly adept at it, displaying a steely determination to punish or undermine those who dare to criticise.

There is good reason to see the strategy at work in the timing of the publication of the Health Service Executive’s report into top-up payments in the hospital and voluntary sector. It seems fairly certain that these details have being published now in order to deter further criticism and distract from further cuts. The evidence on the point, although circumstantial, is compelling.

On Monday, November 5th, the chief executives of four of Dublin’s major hospitals wrote a stark letter to the head of the HSE warning that the hospital system was on the brink and could not sustain further budget cuts. They wrote about the effect of “funding reductions” on “the quality and safety of patient services”. They warned of “unacceptable delays” and how the “shortsighted and random applications of cuts” was undermining the foundations of the hospital system itself.

Service plan
The letter was written as the HSE was completing its service plan for 2014 and in the context of the department having to implement additional cuts of €666 million. A key plank of Minister for Health James Reilly’s plans for the health services is the introduction next year of a “money follows the patient” funding system for many aspects of hospital care.

In this letter, however, the hospital chiefs pointed out that the structure and information system necessary for its introduction were not nearly in place. They also wrote that the suggestion that such an approach would save significant money “clearly misunderstands the nature and dynamic of hospital services”.

What must really have upset the HSE and the Minister, however, was that a copy of this letter quickly found its way into the hands of Katie Hannon, the political correspondent of RTÉ’s Prime Time and that it featured extensively in Prime Time’s programme on November 5th. The resulting media and political storm put further pressure on the HSE senior management and on Dr Reilly who was already on the back foot after disastrous outcomes for his department in the October budget.

Meanwhile, separately, the Irish Independent’s health correspondent Eilish O’Regan had for months been seeking details through Freedom of Information about an audit which the HSE was conducting into top-up allowances paid to hospital chief executives and other senior managers in the voluntary health sector. The HSE had resisted her requests.

The report of this audit, it seems, was presented to the board of the HSE in March, 2013, but had never been published. Then, out of the blue, on Thursday, November 14th – just over a week after the Prime Time programme, the Dáil Public Accounts Committee was surprised to receive from the HSE full details of the audit report. Details of the audit were sent on the same day to Eilish O’Regan.

There then followed days of extensive newspaper coverage of the details of the HSE audit. There was widespread, and understandable political and public outcry, even more so in recent days as the focus switched to how the funds of a charity, Friends of the Central Remedial Clinic, were used to pay a massive top-up to the clinic’s former chief executive.

Any respite the HSE and the Minister might have hoped to enjoy while the media and opposition focused on these top-up payments will be shortlived, however. The audit report and follow-up hearings at the PAC will raise broader issues about oversight in the health sector and indeed about the delivery and funding of much of the health services through voluntary and charitable bodies.

On the Prime Time blog this week Hannon wrote a piece asking how top-up issues were allowed to fester. She queried the extensive political focus on this issue right now, eight months after the internal audit report was delivered, and a full 17 years after the issue was first raised in the Dáil. In fact, the audit report itself suggests that the HSE was aware of a pattern of top-ups in 2008.

If this month’s release of the HSE audit report on top-ups was indeed designed as a spin grenade, it’s one that may yet roll back into Government territory before it detonates.

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