Thursday 18 December 2014

Divide and conquer the dragon

The time has come to consider giving Health its own Minister for Public Expenditure, writes John Drennan

Published 03/11/2013 | 02:00

Minister for Health James Reilly is looking for €666 million in savings
Minister for Health James Reilly is looking for €666 million in savings

One of the distinguishing features of Brian Cowen's premiership was the uncanny resemblance the former Taoiseach developed to those caged dancing bears that are so popular among tourists in the Balkans.

Of course, if the tourists knew the poor bears were taught to dance by having hot irons attached to their paws, they might clap less enthusiastically, but, generally when you are being entertained, few bother to look behind the curtain to see how it's done.

Right now, in a manner that eerily resembles our past game of 'Poke the Biffo and watch him growl', poor James Reilly is certainly the dancing bear of this administration.

But, amid all of the laughter accompanying Dr Reilly's gyrations, are we becoming too like the tourists who laugh without knowledge?

In the case of Enda's Dr Hyde, the task facing the Health Minister is epitomised by the astonishing spectacle where ministers now pray that should Reilly experience an awfully big fall, one of their political rivals rather than their good selves will get to feast on the corpse of this poisoned political pup.

Significantly, Dr Reilly is not unique in his travails for plenty of other ministerial knights have raced in to take on the Health dragon and left in a fairly barbecued state.

Even the dynamic tag team in Finance, Michael Noonan and Brendan Howlin, were bruised by their Health experience. Micheal Martin survived by virtue of avoiding as much decisive action as possible and by throwing as much money as he could at the thing but even Micheal came into the department as a future leadership contender (many suspected that was why he was there in the first place) and left as an also-ran.

Cowen only survived in Health by keeping as low a profile as possible, but, while that trick didn't work quite so well later, at the time Biffo was commended by our politically 'knowing' commentators for the cunning manner in which he managed this ministerial 'Angola'.

It was certainly a stance that Mary Harney might have regretted not adopting, for though more than a match for Bertie Ahern in terms of political cunning, the PDs' self-proclaimed lioness was politically neutered after little more than a year there.

These collective precedents meant the cheers of his colleagues when Reilly raced into his department like a one-man Charge of the Light Brigade were disingenuous on a number of fronts.

On a simple careerist level, the murmurs of delighted faux

sympathy about "poor James and the impossible job" were understandable. It was, however, also profoundly damaging for we need to expect more from our politicians than fatalistic cynicism about the status of the department as an elephant's graveyard for leadership threats or idealistic naifs.

A great degeneration may be taking place in many elements of Irish public life, but, we are not yet at the point of abandoning all hope that a latter-day Donagh O'Malley might come out of left field with a bracing reform agenda.

In the case of Dr Reilly's failing attempt to be that man, he is undoubtedly the author of much of his many misfortunes for his 'kitchen-cabinet my way or the highway school' of management was always going to be drowned by the coalition of self-interested mandarins within the HSE.

However, this, ironically, may provide the Health Minister and his Taoiseach with an accidental solution to the minister's current woes.

One of the salient principles of any war – and whether it likes it or not, this Government is at war with the Health incubus – is that if you are faced with a coalition of enemies, you try to split them up. The other principle which Dr Reilly is learning the hard way is that if you go to war on two fronts, you will inevitably lose.

One solution may be provided by Michael Noonan. The Finance Minister may be Ireland's designated national grandfather now but a question worth asking is how Noonan would fare if he had to cope with Public Expenditure as well as taxation, the 'Prom notes' and the rest of the nest of hydras he inherited.

With the best will in the world, it is more than likely that Noonan would have been left frazzled and distracted by the impossible task of fighting on a multitude of fronts.

It is perhaps time therefore that we should consider the need to split the Department of Health in a similar manner to the division between Finance and Public Expenditure.

It will be argued that this split has already occurred, courtesy of the creation of our by now notorious HSE, which was supposed to run the service while ministers engaged in abstruse philosophical musings about health policy.

The problem with that, however, is that while the HSE acquired the fiscal power, the poor Health Minister maintained the political and public responsibility for the state of our health services.

Reform, ironically, created the worst of all political and administrative worlds where the HSE essentially has power without responsibility and the minister has responsibility without power.

As Dr Reilly reaps the bitter billion-euro fruits of the uncontrolled state of the health sector, the situation is complicated further by the fact that the Health Minister came to office promising a fundamental reform of Ireland's health system via the Dutch model of universal health insurance.

That was always going to be a difficult task given the hornet's nest of comfortably apportioned vested interests who would not like to have their cosy home disturbed by

a nasty dose of State socialism unless the price was right.

The minister's plans in that regard have inevitably been sunk without trace by the scale of his other woes in trying to disentangle the great HSE apogee of the toxic combination of Bertie and Social Partnership, where not one single job was left unsaved by this strange amalgamation of the nine health boards.

The fiscal, administrative and moral squalor Reilly inherited means there is no shame and much honour to be gained by an admission that the job of managing our ungovernable health service is too much for one minister.

And even if he doesn't want to do so, the simple fact is that if Dr Reilly is to be saved, Health needs to be divided in a similar manner to Finance. Reilly can then be left to apply his undoubted knowledge to matters with which he is comfortable such as the Government's core policy of health insurance while a dedicated minister is sent in to put manners on the HSE rogue state.

It might seem to be a radical step to give Health its own Minister for Public Expenditure but departments change, and it is not so long ago since Health and Social Welfare were actually one department.

In fact, on one level, this division may already have happened by stealth, courtesy of all the 'help' Dr Reilly is receiving from the Department of Public Expenditure and the Taoiseach. Though he is 'reportedly' delighted with the help, the problem for Dr James is that when these surrogate controllers return to their own empires, his authority will resemble that of a satrap who is left in charge after the big powers leave.

As for who might be fit to do the job, it would be hard when the reshuffle occurs to look past Brendan Howlin, for no other minister would have the knowledge, the experience and the will for such a task.

In a world where smiles are rare, the very prospect of Dr Reilly's thoughts on Brendan Howlin trotting in to give him a permanent hand in Hawkins House should raise the national morale more than any trip to the World Cup in Rio.

Sunday Independent

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