Monday 29 August 2016

We would love to think Reilly can reform the health system – but our confidence is shaken

Published 14/04/2014 | 02:30

Health Minister James Reilly
Health Minister James Reilly

A friend of mine used to argue that the hospital car park was a metaphor for the entire health system. Often up close to the doorway of the main building, you'll find the staff car park. Patients and visitors have to make do with pay parking, often quite some distance away.

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It is a harsh judgment and perhaps unfair to the thousands of dedicated care workers who really invest a lot in the care of their patients. But it does catch the air of the hospital as an industry, a provider of work and income, and a focal point for other associated businesses.

There is a simple commercial reality to all that. The furore when a small hospital in one of the country's market towns is earmarked for closure is as much about jobs and local business losses as it is about medical care.

Just last week, we heard the Health Minister, James Reilly, pictured, talk up the Irish health sector as a generator of wealth and jobs. He spoke of inward investment and the development of cutting-edge technology.

But in staying with the business analogy, one of the dispiriting things about Irish health policy is the air of despondency that often pervades it. A certain view that it will never really be possible to deliver value for money spent. Many good things happen in the health sector. But many things stay depressingly the same.

One of these is that many readers of this piece pay three times for health care. Firstly, through taxes as €1 in every €3 goes on health. Secondly, on some form of health insurance – if you can still afford to keep it up – because we do not trust public care. Thirdly, we pay €50 or €60 to visit the doctor and whatever else additionally at the pharmacy.

Dr Reilly has promised to change that sometime in or before 2019. And few of us really believe him for a variety of reasons – much as many of us would dearly love to.

It is interesting to note the level of cross-cutting tensions within the Coalition Government on the issue. For one, the idea of free health care at point of delivery – funded by mandatory health insurance – was originally Labour's idea launched by their then leader Ruairi Quinn in 2002. We can understand a certain level of tension generated by Fine Gael stealing Labour's clothes. But there is also a sense that many within Labour believe, that even with the fairest wind at its back and a few lucky breaks, this concept of universal health care will be very difficult to deliver.

That dread is compounded by a fear that Dr Reilly and his department may not be up to the job.

Within Fine Gael there is a dread that your solid Fine Gael voter is more usually the type who has health insurance. Fine Gael TDs and senators fear there may not be a serviceable answer when they are asked what extra benefits universal health care will bring them.

The stalwart voter will continue to pay health insurance at much the same ever-increasing prices. But he or she will not be able to queue-jump for elective operations.

It would appear that the only incentive on offer for such people will be free GP care and no charge at the pharmacy. That in turn raises some interesting questions about the sequencing outlined for the phasing in of the entire system by 2019. But we must keep those for another day.

But Dr Reilly and his team soldier on, and Taoiseach Enda Kenny makes the usually supportive noises when asked.

Confidence is not enhanced by the frequent calamities in the day-to-day running of services.

This very week brings us two of these. Public Expenditure Minister Brendan Howlin insisted yesterday that the Health Service Executive would not have a €200m shortfall in savings under the Haddington Road Agreement. But the HSE batted back with a pretty firm public message that, in fact, it will not meet that target as Mr Howlin says.

Dr Reilly is in the same 'sorry-no-can-do' corner with the HSE. And yet again it is all very public.

Then tomorrow, Junior Health Minister Alex White will get Cabinet approval for free GP for children under six years, an early staging post on the bigger journey to 2019. That will be the easy bit – then there is the little detail of getting the doctors to agree. That is bedevilled by huge doctor resistance and not a little doctor inter-union tensions. Mr White says he is ready to talk – but it is all very complicated.

Yet despite these and many other misgivings, this writer is prepared to give a fair wind to Dr Reilly and the Health Department in their efforts to break out of the current framework and do things radically differently.

In doing so, we must accept that it will take time and that timeframes set out will probably be missed.

But, in saying all of that, we must also apply the old 'continental system' of guilty until proven otherwise.

In other words, we will be surprised, albeit agreeably surprised, if Dr Reilly's brave new world ever does materialise.

Irish Independent

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