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Jerome Reilly: And here's another fine mess that Dr James Reilly got himself into

Chock-full of bluster and weasel words, James Reilly put in an astonishing performance on Prime Time on Thursday night. But worse still, the minister played fast and loose with the truth too.



Dr Reilly denied making a U-turn on the plan to implement cuts to HSE homecare services -- even though his Taoiseach, who can assimilate cold hard facts as well an anyone else of moderate mental capacity, had actually congratulated his cabinet colleague on his volte face.

Further, Dr Reilly said he regretted the fact that disabled people had to stay up all night in the cold outside Dail Eireann because of the fear they felt that their services were going to be withdrawn.

This, Dr Reilly declared with a straight face, was because of the media. The accusation he made was that the whole issue of health cuts to home care, that people would be forced to leave hospital and go home for the weekend to save money on staff wages, was a fabrication. It was never going to happen, he claimed.

Really? Examination of the chain of events of the last week or so provides some clarity on the validity of James Reilly's Prime Time "filli-bluster".

THURSDAY, AUGUST 30

Neither Dr Reilly nor his director-general designate Tony O'Brien (annual pay €195,000) were present when HSE officials announced how they were going to save €130m from the health budget.

The HSE officials, sent out to do the dirty work by their executive and political bosses, were disarmingly clear in how they were going to achieve this troika-ordered saving, which would help eliminate its overall €259m deficit. The officials admitted that older people and the disabled featured strongly in the cost-slashing package.

Some 600,000 home-help hours would be cut -- notwithstanding that this would be the second time this service has been cut this year.

Another €10m would be saved through a reduction in personal-assistant hours for the disabled.

Another €1.7m would be saved by reducing 200 monthly homecare packages.

The advocacy group Inclusion Ireland quickly identified that the €10m cut to personal-assistant hours would be a disaster. It said personal assistants were a critical component in enabling people with disabilities to live independent lives in their own homes -- a frightful irony in the week that the Paralympics got into full swing.

Those with disabilities, their families and those who want only the best for them quickly came to the same conclusion.

FRIDAY, AUGUST 31

Dr Reilly effectively disappeared for more than 24 hours -- though his spokesman reassured anyone who would listen that the minister was in "constant phone contact" and aware of every move.

He reappeared at around 1.10pm on Friday outside the Department of Health building on Poolbeg Street, a stone's throw from Mulligan's pub.

He conducted what is now termed an "official door-step" -- where the media get advance notification that a minister or Taoiseach will answer questions informally on the street.

The Sunday Independent was there, along with TV3, the Irish Times, the Irish Independent and various representative of independent radio.

Here is what James Reilly said in relation to the cuts: "The first thing to explain is that every penny we spend now is borrowed money and that comes with terms and conditions attached by the troika.

"We have sought, and I have made it my principle objective, to ensure that patient services are the last thing to be cut and that patients themselves would always be put first.

"So in relation to these announcements, in relation to these various cuts which now relate to the home-help, homecare area, this is more in the area of probity and efficiency than anything else.

"In other words, I want to give a categoric assurance that everything will be done to ensure that patient services are maintained. The reduction in hours should be achievable in the main through more efficiency and that each case will be looked at on its own merits and, absolutely, the principle that no client of the HSE should end up in either long-term care or hospital care because of a change in their home-help or homecare arrangements."

But Dr Reilly agreed that the changes in the homecare/home-help arrangements "would be noticed" by HSE clients.

He told the assembled journalists that €1bn had been taken out of the healthcare budget last year and that 6,000 staff had left the service in the past year. Dr Reilly then pointed out the increase of 148,000 in the number of medical cards being issued -- at €1,200 a head -- and a six per cent rise in admissions to A&E departments.

Then he added a kicker

"But I have to tell you, there's an elephant in the room, folks. If 70 per cent of my budget is pay and if in some of the NGOs it is up to 90 per cent and community services far in excess of 70 per cent then the point comes when you have to look at pay or start cutting patient services. Now as a doctor and as a minister, I want to see patients and patient services protected.

"So I am going to be asking those -- and this is a broader government issue than just health -- that some of the best-paid people in the State and some of the best people too have to shoulder some of this on behalf of the country when the nation faces the sort of strife it faces now in terms of its finances."

In short, Dr Reilly confirmed that there would be cuts in hours for home help and home care but this would be managed as well as it could and the reason was because he couldn't cut pay because of Croke Park.

SUNDAY, SEPT 2

The storm rumbled on in the Sunday newspapers and Tony O'Brien (annual salary still €195,000) went out to bat on RTE's flagship This Week programme.

Like the minister, he was candid. He said the cuts announced by his officials would lead to bed and theatre closures because the Government had ordered cuts of €130m be implemented to provide assurances to the troika.

There was the first sign also that the cuts might not be set in stone and could be replaced by other cuts if they were guaranteed to save €130m. But he warned that if the reduction in spending was not introduced, the HSE would be heading to a deficit of €500m, which would mean it would run out of money before the end of the year and this was not an option.

Asked if the reductions in overtime and the use of agency staff would lead to bed and theatre closures, Mr O'Brien replied: "Absolutely." He said the cuts represented "significant challenges" and could not be made without some impact on the availability of beds.

Every measure would be subject to a risk assessment and every measure would have to pass that test, Mr O'Brien said.

TUESDAY, SEPT 4

After a lengthy cabinet meeting, the Government ordered the reversal of the €10m in cuts affecting the disabled.

The meeting agreed that Dr Reilly would direct the HSE not to proceed with planned cuts to personal-assistant hours, which were projected to save €10.8m between now and the end of December.

Dr Reilly said that the savings would now be made through cutting travel and subsistence costs in the disability sector. Cuts to home-help services would still go ahead but the HSE would assess each application for home help according to individual needs.

Dr Reilly said savings would have to be achieved from the total disability budget of €1.4bn a year. He also confirmed that he had instructed the HSE to make adjustments across the sector by cutting administration, training and travel costs and through better management of the money handled by the agencies involved.

Wednesday, Sept 5

Just in case everyone wasn't aware that the Government had made a U-turn, Taoiseach Enda Kenny made it abundantly clear that is exactly what his Health Minister had done.

He insisted Dr Reilly should be "admired" and was "courageous" to reverse the cuts to personal assistance care.

Thursday, Sept 6

Speaking on Prime Time, Dr Reilly nevertheless insisted that there had not been a U-turn.

He said: "The (cut in personal-assistance hours) was never going to happen. From my view, there hasn't been a U-turn but that is not the issue, as far as I'm concerned. I'm not bothered as to whether this is described as a U-turn or not, as long as people have the service that they need. And that's my prime objective here."

Later, he added: "I think, I came out, I know, on Friday, and I made it very clear that the service was not going to be lost to people. Tony O'Brien came back on the radio on Sunday and said these would be absolutely the last resort, that every other area would be exhausted.

"For (the print and broadcast media) to ask people, you know, what's it going to mean to you to lose half your personal assistance hours or half your home-help, that was never going to be the case.

"But that planted in the public's mind and in people who need these services' mind immediately that this was a real risk to them.

"And that's why I met with them on Tuesday, when they were outside the Dail, to reassure them further again that this was not going to be the case and I issued a statement.

"They didn't hear it with all the noise that was going on over the weekend in the media, they didn't hear Tony O'Brien in the media, making the statement he made as clearly as he did. And they needed further reassurance, which I was very happy to give them.

"And Tony O'Brien gave them further reassurance again, by way of letter, which he promised to have delivered by 2pm the following day."

Sunday Independent