Kathy Sheridan: We have the right to know who is obstructing desperately needed Sláintecare

In his early Apple years, Steve Jobs managed by sheer mental force to generate a “reality distortion field” (RDF) that could redefine what was possible. Or so it was said. He refused to accept limitations that stood in the way of his ideas, first by convincing himself, then – because the “field” was so powerful, obviously – convincing others that they too could do the impossible.

It all sounds like think-yourself-to-success hooey. It also sounds a tad dangerous. It was similarly visionary monomaniacs who brought us Brexit and other catastrophes.

And yet as I tap this out on an iPhone far from home with hundreds of “cuttings” in the Notes app and every kind of media outlet at my fingertips while checking a flight status and taking a grizzly selfie for the VeriFLY app all on this pretty, hand-sized object, I salute the monomaniacal spirit of Steve Jobs. And wonder, not for the first time, what a character like Jobs and his RDF would do with Sláintecare. No, it’s not like appointing Michael O’Leary to the health department; this is a project in all its exhaustive detail and complexity.

But would even Jobs have had the grit, skill, fearlessness and staying power to bulldoze through the egos, cute hoors, power-mongers and vested interests in health politics?

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Might such a person have already spelt out who and what precisely is responsible for those resignations from the Sláintecare Implementation Advisory Council, “a critical element in the implementation of Sláintecare”, according to the Government only 16 months ago.

Accountability

When a Sláintecare member and management consultant with intimate knowledge of how the cogs turn in State services chooses this stage in the process to stress the importance of external accountability and “a process of reporting in public”, the next obvious question is, why? Why is Dr Eddie Molloy so anxious that the council is “not just a closed group”, that there is “an external role”, that the new group must not “fudge” accountability? Why does he feel the need to state this in several different ways?

The answer, obviously, is that he feels very strongly about the public being treated like mushrooms. Molloy claims not to know why the council chairman and the office executive director resigned last month, but he knows enough to say that the council met resistance, “some of it pretty brutal”, from the Department of Health.

But from whom exactly – and how?

The astounding, infuriating part is that any degree of accountability in a public body is still up for discussion in 2021. And it’s getting very old.

National psyche

The political/religious/medico wars over Dr Noel Browne’s Mother and Child Scheme in the early 1950s is scorched deep in the national psyche. People laughed at Brian Cowen’s description of the Department of Health as “Angola” – ie riven by faction fighting and unexploded landmines – although credit for the bon mot was taken by PR man Paul Allen, who was representing a group in yet another territorial hospital dispute on what he described as Cowen’s “negative disposition”. “It would be interesting to know who was paying PR people to go around spinning against the minister”, Cowen said at the time. “Obviously there are vested interests that one always has to be mindful of.” That was the 1990s.

Cowen’s successor as minister for health, one Micheál Martin, went a step further, reportedly, describing Angola as “honeymoon country” amid chaos in emergency departments and when nearly half the population had been terrorised into buying private health insurance, one of the highest levels of coverage in the OECD.

Twenty years later, we learn, the challenge is to get “buy-in” from people who would lose power and budgets due to Sláintecare’s regionalisation, according to Eddie Molloy.

Brood on that line for a minute. A desperately needed 10-year national plan to save the physical and mental health of Irish citizens, a plan crafted and approved by every democratically elected party in the Dáil, is being challenged by anonymous individuals and groups clinging to power and budgets.

Professional noses

No one said it would be easy. Any ambitious plan was going to get up a lot of professional noses in health politics, an arena far more vicious and vulnerable to manipulation by vested interests than national politics. But we live in a democracy. In the 2020 general election campaign the electorate was led to believe by all parties that this was the one, true path to universal healthcare. If any project could be described as the will of the people, it is Sláintecare.

Some 44 per cent of us paid out for private health insurance last year, the highest level since 2008. The average premium last January was €1,440; for over-65s it was nearly €2,000. What would drive any sane person of any age on an average or fixed income to pay out such sums, if not fear? Why did another 37,000 sign up for health insurance last year?

Yet we have been told repeatedly that funding for health is not the problem.

A person with their own reality distortion field is required. Give Robert Watt teeth. And bring the public inside the process. We have the right to know who is obstructing this plan and why. After lifetimes of fear, grief and being patronised, it’s the least we deserve.