It's the season for sackings and the hot tip is that Reilly will soon be gone from Health
TO lose one minister may be regarded as a misfortune; to lose two looks like carelessness. If political gossip was accurate, James Reilly would have resigned before Alan Shatter last Wednesday. The rumour is that he was persuaded to stay in the post until after the local and European elections. To have another senior Fine Gael minister quit on the same day as Alan Shatter would have been just too politically explosive and undermining for Enda Kenny.
The rumours were fuelled by Dr Reilly going home sick on the day that news broke of Shatter's shock resignation and him pulling out of addressing the nurses' conference last Friday.
Those at the very top in Health vehemently deny these rumours. That said, Eamon Gilmore was out defending Alan Shatter's honour on national media just hours before the Taoiseach announced the stepping down of the Justice Minister.
By Monday, Reilly was out of his sick bed, visiting health facilities in Roscommon, where he was greeted by a small noisy protest.
While the reasons for Reilly to go are legion, there were no obvious ones last week. If the Health Minister had gone in the midst of the Roisin Shortall primary-care-centre debacle in September 2012, no would have been surprised. And there have been numerous bumps along the road since then, each of which he has ridden out with his characteristic bumbling.
The minister's failure to deliver on his own key health promises is his main deficit. Last week, the HSE published its latest performance report, which showed a failure to meet targets that Reilly himself had set for hospital waiting times. The numbers are going in the wrong direction, with a doubling in the number of people waiting more than eight months for essential hospital treatment at the end of February, compared with January.
This report also shows a €54m HSE overspend at the end of February, significantly higher than February 2013 when it was €40m over budget.
The long-overdue free GP care is currently stuck in 'talks about talks'. And in some areas, such as prescription charges for medical card holders, the fee has been increased five-fold since before the 2011 election, when James Reilly condemned their introduction and promised to eliminate drug charges for the poorest and the sickest. Contradictions abound.
However, it is the persistent reports of sick people losing their discretionary medical cards and the unviability of James Reilly's model of Universal Health Insurance (UHI) that are gnawing his political capital to the bone.
Dr Reilly has put his political thick neck on the line with his model of competing private health insurers, despite pretty much everyone else recommending other options – either a social health insurance or tax-based model of universal access. Very few people, inside or outside of Government, consider the proposed UHI either affordable or likely.
That said, the minister should be lauded for championing universal access to care, free at the point of delivery – even if vested interests and politicians are against it.
Interestingly, even Fianna Fail, which happily oversaw and further institutionalised the two-tier health system for its 14 years in government, is now talking about universal healthcare. And the doctors are too.
Yet, political and health circles are awash with conjecture that it is purely a matter of when, not if, Reilly will go.
Paddy Power is offering odds on Leo Varadkar being the next health minister at 10/11. Are we really to be subjected to another GP as health minister? Varadkar has been notably silent on health policy matters but it is likely that he would bring to Health a similar 'entrepreneurial' GP approach to the Health ministry.
That said, if Kenny thinks Reilly has run out of road (and that's the most likely reason Reilly will go), he will act swiftly. We have witnessed how ruthless Kenny can be, even to his closest allies, as was evident with the swift ditching of both Flannery and Shatter when the moment came.
If the Taoiseach wants to test the West Dublin young pup, then there is no better place to send Varadkar to dampen his political aspirations than the Department of Health.
There is also talk from cabinet ministers of rejigging government priorities or a 'renewal of purpose' for the Government.
This provides an opportunity for a new health minister to try to undo some of the damage done by the discretionary medical cards and to come up with a more politically acceptable version of universal healthcare.
The Government, like all governments in their third year, now has its eye on the next general election, not the promises of the last one. And if the political punters and betting odds are right, it won't be James Reilly leading the health system into the next general election, whenever that may be.
Sara Burke is a health policy analyst. She is a post-doctoral research fellow at Trinity College Dublin. Twitter: @sburx