Maeve Sheehan: Axemen cometh after Reilly's plea for help with cuts
The Taoiseach has sent a top team of advisers to slash €666m from the health budget
Published 03/11/2013 | 02:00
THE Taoiseach has dispatched the country's most senior civil servant and his top economic adviser to help Dr James Reilly sort out the financial problems in the Department of Health.
Enda Kenny has appointed Martin Fraser, his secretary general, and Andrew McDowell, who is his chief policy adviser, to liaise with senior managers in the Department of Health and the Health Service Executive (HSE).
Robert Watt, the secretary general of the Department of Public Expenditure and Reform, will join them in going over the books of the beleaguered department.
And the crack squad of bureaucratic brains will work directly with the secretary general at the Department of Health, Dr Ambrose McLoughlin, a former health board manager.
The Taoiseach's top team was invited in by the Minister for Health in the contentious aftermath of Budget 2014.
Faced with finding savings of €666m in a department already cut to the bone, the Minister for Health said he was "frankly speaking – concerned".
He was particularly worried about a target of saving €113m from the medical card bill "allocated" to him by the Minister for Public Expenditure and Reform Brendan Howlin.
"And that's why I asked for the Taoiseach's department and the Department of Public Expenditure and Reform to be involved in assessing and validating these figures, and also the impact they will have on the service," he said.
But Dr Reilly's "invitation" to the Taoiseach was strictly speaking more of a "challenge", according to health sources.
If Kenny and Howlin are imposing savings targets on health, let them identify what services can be cut to make the savings. It seems the Taoiseach – who favours the interdepartmental approach to problem solving – has responded to the invitation by appointing his best brains to the job.
Fraser – a classic civil servant – is used to knocking heads together to find solutions.
As chairman of the Priory Hall talks, he achieved a solution in three weeks to a scandal that had rolled on for two years, leaving residents of the death trap apartment complex homeless and owing huge loans on worthless apartments.
McDowell, who is on the economic management council with members of cabinet and their advisers, was chosen by Kenny for his ability and a reform agenda.
Watt has had many combative showdowns over the savings to be made in health. When last year the HSE questioned the savings that could be made under the Croke Park agreement, the Department of Public Expenditure and Reform issued a statement suggesting that this was the fault of health managers who were not realising the potential savings.
They will work closely with McLoughlin, who is secretary general in health and formerly a dentist and health board manager. Most recently he worked for the Pharmaceutical Society of Ireland and pharmacists are one of the vested interest groups that are being targeted for further savings.
Ultimately, the person who will be most under the cosh is the HSE's director general Tony O'Brien, who remains the "accounting officer" in charge of the money.
His financial management skills have been criticised in the past – by both the Department of Health and the State spending watchdog for breaching financial guidelines at a time when he was chief executive of the National Cancer Screening Service (NCSS).
He – and his national directors – will have to translate the savings identified in the budget into tangible cuts, and given the size of the task he has already got the deadline extended.
It is understood the group has yet to have its first formal meetings. And no deadline has been set for it to produce a result. Instead, the secretaries general and the Government's top policy adviser will work for "as long as it takes" to find areas to cut, while trying to maintain frontline services.
Dr Reilly eventually wants to take charge of this financial quagmire, by transferring responsibility for the health budget from the HSE back into his department.
In the meantime, despite a frightening overspend on health this year of €150m to €200m, the minister claims the financial "black hole" is no longer there as every cent is now accounted for.
Whether the Taoiseach's top officials will fare any better than the health service managers in finding previously untapped savings remains to be seen.
But one thing the Taoiseach and the Minister for Public Expenditure and Reform will bring to the table is "political cover" for Dr Reilly when it comes to sanctioning unpalatable cuts that will almost inevitably hit front line services.