Miriam Lord: Government faces stampede of elephants in the room

Róisín Shortall savages Coalition’s lack of political will in implementing Sláintecare

And then, just after midday, the Dáil was overrun by elephants.

Rampaging across the floor, eating buns and trying to squash their behinds into the fold-down seats.

It was impossible to see past your nose for all the baggy trousers and flappy ears.

Elephants in the chamber? Not the first time that’s happened, some would say. But surely only after midnight, when TDs are forced to abandon the bar for a late vote?


But this was about trunks, not drunks.

The Minister for Public Expenditure and Reform identified a very large elephant in the middle of Leaders’ Questions. Michael McGrath, standing in for the Taoiseach who is on a different safari in America, was at a loss to understand how Róisín Shortall, seated nearby, could not see it.

Perhaps it was because the Social Democrats co-leader was too busy firing a few uncomfortable “deliverables” back at him. This was Michael’s big word during a wishy-washy defence of the Government’s stewardship of the ambitious 10-year Sláintecare health programme, which is in danger of going off the rails.

She warned him of the gravity of the situation, citing the recent resignation of the two senior managers hired to drive the reform, swiftly followed by the chair of one of the country’s largest hospital groups, who quit because “much-needed reform of the health services has not been delivered”.

Róisín is in no doubt that the blueprint, wholeheartedly agreed on a cross-party basis in 2017, is running into the buffers because the Government has neither the will nor the backbone to “take on the vested interests” standing in the way of its implementation.

It’s down to a lack of courage and leadership at the top, she reckons. Where is the political will to get Sláintecare done? The TD for Dublin North-West contrasted today’s faltering project with what happened a decade ago when Prof Tom Keane (one of the people who have just resigned) reformed cancer services in the face of huge controversy. He was able to do this because “he had the staunch support of the then minister for health, Mary Harney”.

Where is that single-minded commitment now?

But, but, but... insisted McGrath. Never mind the quality, feel the “deliverables”. The Government is throwing money at the problem and will be flinging even more cash at it in next month’s budget.

‘Real funding’

He sounded a bit hurt by what Róisín had to say, particularly as the “really significant manifestations of the Government’s commitment to Sláintecare is backed up with real funding”. As opposed to makey-uppey funding.

Michael surveyed the chamber. “But what you didn’t even mention is the elephant in the room... you didn’t even feel it was worthy of a mention.”

Strong political will is the key. Otherwise our banjaxed system will keep eating up the money. It's like throwing buns at an elephant

Let’s be reasonable here. The Government can only handle one elephant at a time and they have had their hands full with a wild bull called Covid and he’s been creating havoc for 18 months, Michael explained.

But that’s only a Johnny-come-lately elephant, sighed Róisín. Sláintecare was on the scene well before Covid arrived. It’s a 10-year plan. The Coalition is “downplaying” the extent of the crisis because it hasn’t the nerve to face up to “serious institutional resistance” from within the HSE and Department of Health. This resistance is a really serious elephant.

She could see it herself in the Dáil chamber. It’s huge.

"Now, if you persist in refusing to acknowledge that elephant in the room, we're not going to make any progress on this."

And while the Social Democrats will support what is likely to be a record injection of funding for the health service in the budget, – God knows, it’s needed – “the party does not believe in repeatedly pumping large amounts of public money into a dysfunctional health system. Money alone will not solve the endemic problems in our broken health service.”

Strong political will is the key. Otherwise our banjaxed system will keep eating up the money. It’s like throwing buns at an elephant.

No choice

For starters, find out why the senior health officials felt they had no choice but to resign their roles heading up Sláintecare. It’s been nearly two full weeks since they walked and nobody in Government seems to know exactly why, and if they do, they aren’t saying. The Minister for Health had a telephone conversation with one on them, apparently.

Again, the Minister brushed over the real concerns about the delay: vested interests trying to scupper a meaningful overhaul

“Of course the Government acknowledges that the resignations were deeply disappointing. Of course we acknowledge that,” soothed Michael McGrath, 12 days after the event.

“What are you doing about it?” shot back Róisín Shortall, not unreasonably. “The Government needs to stop ignoring the elephant in the room.”

But it is. He neatly sidestepped the worrying charge of “institutional resistance” blocking reform, choosing to get the wrong end of the stick. “There is absolutely no resistance within Government at a political level to delivering on these reforms.”

He was tackled on this again by the Independent TD for Galway West, Catherine Connolly, who also accused the Government of hiding behind the pandemic to excuse the delays in implementing the programme. She too reminded him of the timeline involved. Unless the Coalition is trying to backdate the pandemic, Sláintecare was a couple of years up and running before Covid struck.

Brushed over

But all Michael McGrath could do was insist that they are doing everything they can to get the programme implemented. Again, he brushed over the real concerns about the delay: vested interests trying to scupper a meaningful overhaul of the health system for all members of society.

He promised the removal of “any obstacles and any roadblocks that there are within the system – because they are not at a political level”. They have the “resources” to do this.

If only resources were the solution. The Minister has clearly admitted that the blockage in delivering Sláintecare is not at the political end.

If the radical blueprint to regenerate the health system is to succeed, it looks like the Government needs to find a Mary Harney-type figure to tackle the vested interests, bang heads together and demand results.

Maybe straight-talking Robert Watt, the much-lauded new boss at the Department of Health, is the person do it.

Could Watt be the new Mary Harney? Could that be the reason he was headhunted from the Department of Public Expenditure to Health?

Maybe he might more than justify his €90,000 pay rise and earn his spurs by shooting the elephants his political masters are too scared to touch.

That would be one deliverable worth boasting about.