Irish Times on Fine Gael’s Policies.PLUS Bill’s Comments. HSE staff please note.

Fine Gael’s policies

THERE IS nothing wrong with being ambitious in politics, but making exaggerated claims can be fatal. Fianna Fáil lost the confidence of the electorate through its mishandling of the economy and repeated assurances that the worst was over. Fine Gael is now treading the same dangerous ground by publishing policy documents that are heavy on aspiration but light on timescales and implementation details. In present circumstances, the public deserves straight talking, rather than old-style political slogans.

Publication of a policy document entitled “Reinventing Government” at the weekend was designed to attract publicity and confirm Fine Gael’s position as a government-in-waiting. But party leader Enda Kenny found himself on the defensive when he was unable to explain satisfactorily what would happen to HSE administrative staff when Fine Gael dismantles that organisation. To suggest they would be re-employed by private sector insurance companies under a reformed, single-tier health system was hard to credit. In the same way, promising to protect the vulnerable in society while cutting expenditure and making State services “smaller, cheaper and better” failed to convince.

Pledges to “dismantle” the HSE ; to “abolish” Fás or to “make a bonfire of 145 quangos” suggested a no-nonsense approach to reform and was designed to generate attractive media soundbites. But such undertakings fail to acknowledge that the functions of these organisations will not be extinguished and that new entities are likely to emerge. Describing these commitments as “the big picture”, Mr Kenny appeared to be unwilling or unable to deal with the implications of policy decisions. He did not inspire confidence. Part of Fine Gael’s difficulty may lie in the fact that its policies have been overtaken by events. A rapidly worsening fiscal situation meant its original plan for restoring the public finances and providing an economic jobs stimulus had to be revised. In the same way, “Reinventing Government” represents an expanded and updated version of an earlier “New Politics” document. Its “FairCare” policy proposes the establishment of a universal health insurance scheme and the dismantling of the HSE over five years.

Fine Gael has undertaken to cut the number of public servants by 10 per cent through voluntary redundancies and natural wastage. It has accepted the Croke Park deal in terms of pay. But State pensions are a separate and still uncertain issue. It promises to cap public sector salaries at €200,000 but this cannot apply where employment contracts exist. Offering more than can be realistically delivered damages credibility. The party has produced a useful analysis of what is wrong with the political and administrative systems and offers various paths forward in cutting expenditure and introducing reforms. Citizens of this State are facing into what are likely to be extremely tough and painful years. Pretending otherwise can only feed into a negative perception of politics and politicians. Straight talking and the establishment of clear and socially fair objectives are required.


Having listened to the broadcasts on the above policies I will comment on the Fair Care and New Politics declarations in the forthcoming period. I entirely agree with the above. I am a Irishman who puts my country first above any individual or party. I take risks of most types for that.
An aperatif is that there should be a universal insurance system mandatory for all citizens and subject to open competition for all personal health services. Personal health services in the sense of one-to-one or team services in medicine which will include nurse services. The VHI have various templates at the moment which should be used as an opening protocol. These are overpriced at the charges and paym,ents ends but that is easily rectifiable. There must be a replacement for the HSE which is the reverse of the secretive bullying HSE and hospital administrations. The Department of Health must be reinvigorated and be let lead and supervise. There should be a Health Board for Dublin and the Northeast as the current HSE Region. There should also be a South Dublin MidLeinster and South East Region which should include Wexford and Waterford. The South and Southwestshould be another region as should Connacht plus Donegal. I believe that Northeast Donegal should be integrated with Altnagelvin in Derry. The role of the Erne Hospital in Enniskillen for NorthMonaghan must also be explored.

HSE staff will be treated with respect and advocacy if I am elected in DNW. I will guarantee that I will not be found wanting in backbone. Health Service staff should be lead in teams and have access to open criticisms of their work practices and experiences. Junior staff should be listened to and have access to the media. Why should there be intimidation and gagging clauses in the workplace or publicly owned institutions in an adult democratic society. What are the bosses afraid of? The illumination of discontent which might cause the media to investigate the causes of such griping! The culture of secrecy in the civil and public services in this country has caused serious and expensive damage to this country. That is one of the reasons for the Tribunals of Enquiry. People like me have a hard time in life. It is much easier and far more popular to be a pliant clubbable chappie who thinks the thoughts but never walks the walks.

Now I am fully aware of how hard many staff members work in our hospitals, care homes, in the community and in health centres across the country. I know that many have asked themselves, how can we serve the patients better? Some managerial staff are redundant in the HSE and they know that. Some back-office functions can be centralised including the routine medical card processing, major capital equipment purchasing, drug purchases and others. This requires staff and technical and professional back-up which will not be provided by insurance companies. I have my own ideas on how to provide many services some of which I published in 2003 in “A cure for the crisis”. Each country has its own template for health care provision and none is perfect. You cannot twart supply side economics in patient care. If it takes twenty doctors to do 100 units of work, then no matter how they are paid, they will produce about 100 units of work. I know that individual payments act as an incentive to productivity. Look at the private clinic scene! But no Fair Care will eliminate queues where the demand exceeds the productive ability of those available to supply the service.

The question of paying GPs comes into focus. I think there should be a combination of capitation and co-payment. That means that it should cost most people a some money to go to a GP – maybe €10 to €40 for those not in receipt of social welfare with the rest being covered by insurance. The problem with a completely free system is that demand will swamp the GPs ability to supply the service and rationing by appointment will become the norm. As it happens, I have suggested to RCSI Medical School and to DCU that a Postgraduate Primary Care training school should be established at Connolly Hospital to cater for the medical, nursing and allied professionals needs to supply the most effective modern primary care. This is because the demographics of Irish Primary Care show a looming large shortfall in available trained GPs. The demands of lifestyle and increase in female professionals mean that more are needed to cover the work volume demands. Furthermore, with continuous medical education and training necessary for the upkeep of professional standards and the needs of the European Worktime Directive, staff numbers in general practice have to rise. The explosion of paperwork is also a big burden on GPs further reducing patient throughput.

The new consultants contract must be binned immediately. Professionals must be held to account and money must follow the patient. The latter mantra must be retained and made manifest. I will not rest as long as medicine is impinged by silencing clauses and inappropriate pressures from administrators and ‘medics-gone- native’. I could name a few of them but I haven’t the time for the consequent hassle at the moment. They know who they are and I know who some of them are. The answer is to remore their secret powers and hold everyone to account. Doctors have a duty to the patient first and then to the profession. Hospitals are merely buildings that house interdependent and overlapping medical practices. They should not be what they have become – massive organisational megaliths dominated by CEO go-fors with layers of redundant administration organising futile circles of redundant meetings postponing obvious decisions to the frustration of front line troops. First world war shell shock is mimiced by the shock of participating in the same executive decision on successive three years. Oouch – and you are supposed to say nothing in public! Wow – great system!
Enda Kenny is not a know-all. He needs cogent, rational and accurate advice. I will never refuse my version of this to him. He is a good man and will listen.

PS. If any of you have any influence, make sure that the HSE places an MRI scanner in Connolly hospital.