It’s been a good week to be in opposition in Irish politics. Pretty distressing if you’re trying to keep it together inside Government. Billy Kelleher of Fianna Fail may have been the one who first flushed out Roisin Shortall… but Mary Lou’s been reaping the benefits too…
So what’s the issue? Well, to start at the beginning, the problem relates to the implementation of a strategy in primary health care.
Interestingly, the strategy dates from 2001 (PDF), and was the product of the Department of Health when the current leader of Fianna Fail was Health Minister (to keep him too busy to plot against the Bert, the cynics say).
It was an ambitious plan to create a whole new infrastructure that simply had never existed in the state ever before. The idea was to shift from a full focus on treatment toward prevention, health promotion and well being.
The plan was to set up Primary Care Teams (PCTs) across the country that would facilitate the working together of a wide range of professionals in health from GPs and nurses to home helps. Each team was to work to a population of between 7-15k .
It would necessitate both the recruitment of a lot of extra staff as well as an extensive new building programme. And guess what? It never materialised.
According to Sara Burke’s account in Irish Apartheid: Healthcare and Inequality in Ireland, the initial stumbling block was put on hold until the roll out of medical card accessibility was extended.
By the time that was accomplished, the health budget was under constant and severe restraint.
So, despite a lot of polemic and voluble support from within the HSE, the last government’s plan to roll out 600 PCTs across the country was just one of many policy plans (some like this one, more thought through than others) that were never realised before its dramatic defenestration in 2011.
Where were we? Oh yes, former Minister Shortall (Labour) and her boss, the bluff/blunt gentleman doctor/minister from the relatively wealthy end of North Dublin.
So Minister Reilly walks into office and before he’s done much else, he fires the board of the HSE (a sort of nascent NHS) and tells the world there is going to be great changes around here.
He then (being a GP) takes personal charge (erm, responsibility) for what is now the largest single organisation in the State. Brave, says you. Foolish boy, says another.
This in a government whose Taoiseach has promised report cards and sackings of ministers who do not pull their weight in government.
So, the Minister finally does what his predecessor had failed to do in 10 years and his Labour Minister of State Roisin Shortall is charged with identifying a tranche of ‘shovel ready’ projects across the country.
The intention is as much to create a much needed, if modest, stimulus for the country’s stricken building industry. Shortall identifies 20 projects.
Reilly wants another 15, in part to ensure that they eventually able to enact the minimum figure of 20. He has a fear, which he doesn’t quite explain, that they won’t get buy in from GPs in some areas, leaving them short.
I don’t know Minister Reilly, I’ve never met him. But his ‘bedside manner’ is reputed to leave a lot be desired. Former Minister Shortall is no shrinking violet either. It was the volatility of the relationship between the two that seems to have brought this all to a head.
The straw that broke the camel’s back seems to be the fact that two (yep, not one, but two) of the proposed PCTs are in Dr Reilly’s own constituency. Now despite some speculation (and there have been several lines tried on this), there’s no evidence that the Minister was to profit financially.
But nearly a week after Minister of State Shortall resigned, the Health Minister has yet to produce so much as a memo outlining the criterion used to choose the extra fifteen new build PCT sites.
That, it is now being widely presumed, is likely to be because (unlike Shortall’s first twenty) no such criterion exists. It was a classic case of ‘stroke play’.. Miriam Lord in yesterday’s Irish Times:
…there were loads of lists, blustered Reilly, and all sorts of additional criteria, which he spoke about in incomprehensible detail, but there was no breakdown of how these criteria were applied, what marks were awarded to what locations and what weightings were used.
For all the time he has had to supply this vital information, with all his advisers and important people with access to information in the HSE, James Reilly has not explained. Apparently because the whole story has nothing to do with him.
Minister Reilly may stiff it out. The Taoiseach may back him (just like he backed Phil Hogan through his poor implementation of the household charge earlier this year).
The truth is that government in Ireland (and yes, it is coming to us in Northern Ireland too, since we have the same electoral system in place), depends on using ministerial office to stroke your constituents.
That’s the real political deal, and everyone (outside Dublin at least) knows it. It was a stroke, and was only really stupid because he stuffed two in his own backyard.
The more serious concerns are that he may be out of his depth. In less than two years he’s sacked a board, lost CEO and now a junior Minister. There are now projected budget overruns that will be seen by to be the responsibility of the minister rather than the management of the HSE.
That’s good news for the opposition who are effectively after ‘scrumping’ votes from two trees in quite separate political orchards. But not so great for the country. It put me in mind of this quote from David Kennedy, describing the circularity of politics in the US in its current phase:
…we have a political system that manages to be both volatile and gridlocked — indeed, it may be gridlocked not least because it is so volatile. And, like their 19th-century forebears, today’s politicians have great difficulty gaining traction on any of those challenges. Now as then, it’s hard to lead citizens who are so eager to “throw the bums out” at every opportunity.
The current government is not in that territory, yet. Episodes like this threaten its general sense of direction. But the problem of stroking (or pork barrelling as the Americans call it) could be diminished somewhat with some small, clever changes to government.
You get a sense that everyone is getting too much by being just a little too angry with an unpopular Minster of Health, to consider what kind of solution that distracts Ministers from their national brief to serve their local one instead.