The Reilly Shortall affair: And Ireland’s loss of political direction…

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.

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  • Clanky

    Mick, when has Ireland ever had political direction?

  • Rory Carr

    …there’s no evidence that the Minister was to profit financially.

    Phew ! That’s a relief to know. And quite proper too. Just as it ought to be. But, why then, one wonders, the necessity to exlain that such is the case ?

    Has it been alleged ? Are there whispers abroad ?

    Who am I kiddin’ ? Of course there are. The country is, if not yet ablaze with rumour, ceratinly smouldering fiercly. And, apparently, The Sunday Times is trailing a story that new information yet to come to light will blow both O’Reilly and Gilmore out of the water.

    Oh dear ! I do hope the good doctor has a supply of tranquilisers handy.

  • Mick Fealty

    When they stop trailing and deliver something, we’ll have a story Rory. Until then, just calm down dears.

    There’s enough of a real story here to be going on with, don’t you think?

  • Taoiseach

    Worst person to have in charge of Dept of Health is a GP. Carries a huge amount of baggage and in his particular case a lot of financial problems which will emerge in time (at the moment the money is owed to other investors – it will soon become a bank issue, then NAMA etc). And no one, no one, genuinely believes that Balbriggan and Swords got on the list by accident ahead of Dundalk.

    This could easily become the worst government in the history of the State. Still trying to recover from the sight of Kenny playing with his phone in front of the Pope.

  • Greenflag

    ‘Worst person to have in charge of Dept of Health is a GP.’

    Probably almost always true . But then there was Dr Noel Browne whose progressive views on Health Care at the time did not find favour with the Irish RC Church ayatollahs of the time 🙁

    ‘Scientists should be on tap -not on top ‘ was one of Churchill’s memorable one liners .

    But Mick is not far off the mark when he refers to stroke politics as the elephant in the room . Minister Reilly appears to have been safeguarding his ‘re-election prospects ‘. He can no doubt see political torrents ahead and an electorate that will be sorely tempted to throw the bums out come next election . The problem now being just like in Northern Ireland there is no opposition party with enough credibility to provide an alternative bar SF and they can hope for no more than 17% of the vote .

    Gilmore must be on edge with the loss of Shorthall and his slavish licking of the FG rea end is beginning to more than grate on Labour voters -thus his recent appeal for ‘unity ‘

    The cracks in the coalition are now more than skin deep.

  • Greenflag

    ‘This could easily become the worst government in the history of the State. ‘

    There are now several contenders for that award ranging from Bertie’s Property Bubble Blinded By Greed Ostrich Party -to Cowan’s Gimme a Bailout Here’s the Fax I’m Hiding in a Pub in the Midlands to Dev’s Comely Maiden’s and Sturdy Maidens Dancing at Crossroads Visionary Party .

    They have a fair bit to catch up on if they are to rate 1st place in the ‘Worst Government Award ‘. It’s the new economy syndrome . Competition is tougher than it ever was to get to the top ;)?

  • Blissett

    “the HSE (a sort of nascent NHS)”

    You’re kidding surely?

  • Labour never does well out of coalition. And thats been the case since this coalition was formed.
    But increasingly I think that the Labour Party is fracturing between the traditional Labour and the newcomers from Democratic Left which seems to be justa little too powerful.
    Eventually the Coalition will fracture.
    But so will Labour.

  • Red Lion

    Doctors don’t necessarily make good administrators there is too much of a conflict of interest re feathering their own nest in terms of financial rewards or workload.

    But the first para – there has to be a shift in the NHS, and society in general, to not just treatment but prevention and wellbeing, in an era of cost cutting and wondering how we’re going to fund the NHS, this has to be a cornerstone of thinking from now on.

    The society that drinks less, smokes less, takes regular exercise and has a good diet doesn’t need to access the NHS as much. And yes if the economy is better and people have jobs, and people are better educated the health is better too, but wishful thinking and all that.

    But simple steps can go a long way. The UK seems to be missing a trick with the Olympic legacy. Quite simply, they should have upped the amount of time and resources on PE in schools to at least 3 times a week quality simple fun exercise, and make PE fun for the fat kids – not miserable in freezing cold field but simple games. And call it ‘the olympic project’. The obesity epidemic is no longer in the post it is right here right now and increasing particapation in general exercise for schollchildren would have lessened the dependency on the NHS for the future. And as for smoking…

    Modest financial outlay in the short term (or even a reconfiguring of current investments) can mean very significant long term money savings not to mention a happier population in the short run .. win-win!

    Its joined up thinking between different government departments – health, education, sports, but the d’hont system doesnt lend itself to this type of intergrated government programme, the lack of joined up thinking presently is another reason to move to a more opposition style government