Thursday 14 November 2019

Maeve Sheehan: Political meddling, curse of the health service, is back

The children's hospital location shortlist is coming this week -- but it's no easy decision, writes Maeve Sheehan

LATER this week, Health Minister James Reilly is due to present a shortlist of "options" of proposed locations for a national children's hospital to Taoiseach Enda Kenny and Tanaiste Eamon Gilmore.

They will make their choices and the following week Dr Reilly will bring a report to Cabinet, which will ultimately decide where the children's hospital should be built.

When the process of selecting a location for a national paediatric facility began more than six years ago, independent consultants were drafted in from the UK and international experts were consulted. It was a decision that was bound to be divisive.

At the end of a long and fraught process, the decision on where Ireland's children should be treated will be taken by a group of politicians with a vested interest in their own constituencies.

After the delays that have dogged this incredibly contentious project, it will be a relief to get a decision at all.

But a week ago, Dr Sam Coulter-Smith, the master of the Rotunda, said the location of the children's hospital now "appears to be a political decision, rather than a clinician's one".

In the past few months, Dr Reilly has brought politics right back into the heart of the health service. The Health Service Executive might be a bureaucratic, money-sucking monster. But one of its achievements has been to put key decisions on health care beyond the reach of local politicians.

Parish-pump politics is often blamed by experts for helping to land the health service in the state it's in. They crowded on to every local health board in the country, pushing, jostling and lobbying. They clamoured for hospitals in every constituency in a country with a population of four million, and got them at election time.

Last year, Dr Reilly rolled up his sleeves and got stuck into the HSE. He forced out the board of the HSE and installed his own officials. He pushed out Cathal Magee, the former chief executive.

Decisions that would have been taken solely by the HSE are now in the gift of Dr Reilly, such as the location of primary care centres. Where they are built should be ideally dictated by clinical and demographic need.

But that process has been undermined by the perception of "stroke politics" generated by Dr Reilly when he added 15 primary care centres to a priority list created by his junior minister, Roisin Shortall. Two were in his own constituency and three were in the constituencies of two of his Fine Gael colleagues.

As the events of recent months have suggested, political lobbying is back in vogue and the minister is open for business. Frank Feighan, the Fine Gael deputy for Roscommon has admitted successfully lobbying for two centres in his back yard.

Phil Hogan, the Minister for the Environment, met the minister to discuss primary care centres in February but denied that he lobbied him.

Nevertheless, two primary care health centres have opened in his Carlow/Kilkenny constituency since last year, two more are planned and Dr Reilly added one of them to his priority list.

Mr Hogan has done well in securing health facilities in his constituency. Only months in government, he set about delivering one of his election promises. In early June last year, he announced that the HSE had allocated €13m in its capital plan to upgrade the emergency department and other facilities at St Luke's Hospital in Kilkenny.

The curious thing was that Mr Hogan made this announcement a full month before the project was officially sanctioned by the HSE.

But with the "support" of Mr Hogan and the Minister for Health, Cathal Magee -- the HSE's then chief executive -- and the board sanctioned the €13m funding for St Luke's on July 14 last year.

A regional manager later wrote a letter of thanks to Mr Hogan: "With your own support and that of the Minister for Health, the project was fully approved for development in the HSE Capital Plan 2011-2015 and authorised to the CEO of the HSE on July 14, 2011 by the secretary general in the Department of Health."

The letter was published in the Kilkenny People.

The people of Kilkenny are as deserving of decent hospital facilities as anywhere else in Ireland. And politicians are there to be lobbied for better services.

Political lobbying played a big part in clogging up the health service in the past. And in the past couple of months Dr Reilly has single-handedly resurrected "stroke politics" -- a phrase the current administration had promised to banish from its lexicon.

The perception of political meddling has also lingered over the proposed children's hospital. Some of Dr Reilly's political associates and supporters have been pushing an empty Greenfield site in Belcamp, which will be in his north Dublin constituency at the next election.

Dr Reilly was said to be seriously considering the site, even promoting it -- although he had set up an independent review body to advise him on it.

Recent reports suggest that Belcamp has made the shortlist of options he will present to the Tanaiste and Taoiseach. If they have any sense, they will drop it like a hot stone.

The other options reportedly include Connolly Hospital, backed by Beaumont and the Royal College of Surgeons, and St James's Hospital, Dublin 8.

The original location at the Mater -- and backed by Temple Street and the Rotunda hospitals -- still claims to have the best bid.

However, observers say that politicians have soured on the idea, reluctant to re-open the row about its inner city centre location.

It was reported last week that Connolly would also be difficult, simply because it's in the constituency of two government ministers, which would leave St James's claiming the children's hospital prize because there is no minister in that constituency.

Because, God forbid, that there should be even a whiff of "stroke politics" lingering over their decision.

Sunday Independent

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