Reilly – On Yates watch

He’s flying high in health, but Reilly could still crash and burn By Ivan Yates

Thursday, May 05, 2011

BENEATH the radar of tumultuous politics, Dr James Reilly ascended the greasy pole. Elected at his initial attempt in Dublin North, his rise through the ranks has been utterly remarkable.

My favourite anecdote? On his first day in the Dáil chamber, sitting on the back benches he asked a senior Fine Gaeler “who do you talk to around here to get on to the frontbench?” He obviously spoke to the right connections, being immediately appointed health spokesperson. Within a mere three years he emerged as the biggest winner in the FG leadership heave by pole vaulting all colleagues into the plum post of deputy leader. His prior achievements are stunning. He developed a thriving medical practice in Lusk, has property interests in north Dublin and Tipperary, also owning a magnificent period house and estate in Moneygall, Co Offaly.

Not only has Dr Reilly successfully accumulated considerable wealth, but also distinguished himself within medical politics. This culminated in presidency of the Irish Medical Organisation. Many former presidents of national bodies, such as IFA, GAA and trade unions have entered politics but few have achieved cabinet office. The new health minister has few peers in terms of career advancement and achieving personal ambitions. The fact that he sought this most contentious and difficult job speaks well of his public-service intentions. The skills and attributes that have jet propelled him thus far may not be enough to ensure ministerial success. The politics of health are a minefield. Rory O’Hanlon was branded “Dr Death”. Michael Noonan almost didn’t survive the Bridget McCole debacle. Brian Cowen aptly described it as “Angola”. Mary Harney became one of the most unpopular ministers. In latter years she became arrogant, aloof and remote from a conveyor belt of crises. These included accident and emergency overload with trolley traffic, hidden child deaths in state care, HSE bureaucracy and bonus mania, horrendous cancer misdiagnoses, on/off vaccination programmes and constant battles with various vested interests.

The legacy of Harney’s record creates a tailwind of goodwill for Dr Reilly. Her refusal to be accountable or responsible for the delivery of health care aggravated day to day problems. Any issue that became the politics of the latest atrocity was deflected as a matter for the executive or board of the HSE. The Heath Information and Quality Authority (HIQA) was put in place to oversee HSE standards of care. Everything was at arm’s length from the minister. Reilly intends to take full responsibility for policy and provision. His courage and appetite for the job, along with reforming zeal are to be applauded. He authored FG’s radical FairCare policy. As opposition spokesperson, he fanned the flames of opportunism in attacking Harney, HSE and Government. He has been fast and loose with costly promises nationally and locally. Fear is that this rising star, turned comet, is heading for a medium-term crash landing. Enda Kenny and Eamon Gilmore have fully underwritten his ministerial menu in the Programme for Government.

Reilly is committed to abolishing the 50% prescription charge immediately, free GP access to all over a phased three-year period and reducing hospital waiting lists radically. He promises to provide extra resources to mental health, dental care, capital health spending and an expanded array of home care packages for the elderly. He has expressly undertaken the early completion of the cystic fibrosis unit and construction of a new National Children’s Hospital. On visitations to local hospitals & he gave explicit assurances of continued roles.

His most ambitious endeavour is to transform our health system through Universal Health Insurance (UHI), based on the Dutch model. The utopian objective is absolute fairness in accessing care on the basis of medical need alone. He promises a unified GP system, without private patients — all free. Insurance premiums, like car cover, will be compulsory. The State presumably pays full costs for 1.3 million medical card holders. By the money following the patient, we are assured of maximum efficiency and lowest expenditure.

From these plans, it is impossible to obtain detailed answers to fundamental questions. How does one negotiate a new GP contract, with lower fees, where all patients are treated under one system? How does our dual system of private and public health services match that which existed in Holland prior to 2006, which was based on a two-tier system of health insurance? How do you obligate insurers or provide cover for the uninsured (as done by the Motor Insurers’ Bureau)? How do you transfer 106,000 publicly contracted employees of the HSE and voluntary hospitals into employment by contractors to insurance companies? Key issues are unresolved.

Difficulties of reforming and adapting the health board network into a singular HSE structure seemed relatively straightforward streamlining. Union resistance, complex demarcation and political compromises resulted in bloated bureaucracy. Government’s health plans aim to overhaul our health system. Having jumped into the water, there is no guarantee we will reach the other side of the river bank. This is to be achieved while our bailout brethren seek a 10% reduction in the €14bn cost of health services. Public health expenditure was €3bn in 1996. They will insist on immediate cost reductions.

DR REILLY states, as interim steps to UHI, a Primary Care Fund and Hospital Insurance Fund will be established. His admirable goal is to develop GP practices into local diagnostic centres with extensive treatment facilities. Community pharmacies can contribute to cost reductions through obligatory use of generic drugs and reference pricing of medicines, whereby users are surcharged beyond unit costs. Emphasis on moving patients out of acute hospitals is a no brainer, but the demographics of an extra 600,000 elderly people in coming decades will ensure enormous budgetary pressures. The cost base is primarily demand led.

Dr Reilly inherits closed hospital wards, resulting in hospital waiting lists increasing by 5,000 to 26,000 since December. The staff moratorium will increasingly pressurise front line services and INMO militancy. Medical card eligibility rises as incomes fall. FG promised to secure 8,000 voluntary redundancies, yet last year’s exit only obtained an uptake of 2006 staff. The Croke Park Agreement prevents outsourcing. Revised agreements, through the IPHA deal, lowered drug prices by up to 40%. Low hanging fruit of savings have already been procured.

Political prospects for the government in the health sphere could become a Fukushima-style meltdown. It’s time to ensure the end destination of health reforms are properly understood and explained. Banishing the board members and dismantling the HSE will be the facile part of the process. The rhetoric may rebound as we find we are on the road to nowhere. Dr Reilly has taken total onerous responsibility upon himself and the department. There will be no hiding place if the project collapses. The complexity and specialist sophistication of medicine means the cabinet has left this portfolio to the expert. Dr Reilly is actually a political novice in an arena of powerful vested interests. Our political leaders should not take their eye off this ball as it may yet turn into an own goal.

This appeared in the printed version of the Irish Examiner Thursday, May 05, 201