Friday 6 December 2019

Leo should make a deal with the Irish people

We might be willing to forgo some tax cuts for now in favour of bailing out our troubled health system

Straight-Talking: New Health Minister Leo Varadkar is making no bones about what he thinks needs to happen in the health service.
Straight-Talking: New Health Minister Leo Varadkar is making no bones about what he thinks needs to happen in the health service.
Brendan O'Connor

Brendan O'Connor

In Galway, nurses and midwives were out last week because they feel they cannot stand over the service they are offering people. One of the main concerns they voiced was the fact that terminally ill people are being denied their dignity and privacy in A&E. Can you imagine dying in public on a hospital trolley surrounded by drunks and kids with broken limbs? Can you imagine how that feels for a family, when that most sacred moment, that final journey, happens in a corridor?

An Irish man with suspected prostate cancer is supposed to be seen within four weeks in a public "rapid access" clinic. Prostate cancer can be one of the less sinister cancers to get but timing is everything. Half of these men are not seen within the four-week window. One-third of those men who are not seen will have prostate cancer. That delay could kill them. We also learned last week that despite being world leaders in obesity and diabetes we have the worst diabetes care in western Europe.

We have CEOs in major hospitals saying that they don't feel hospitals in our capital are safe for patients. We demonstrate no political will to build a hospital for our children and have been making do with patching up for several years an institution that, despite the best efforts of the staff there, can be a nightmare for vulnerable and dying children and their families. The IMO said during the week that it reckons the health service is at breaking point and our health infrastructure is ready to collapse to a point where it will take decades to fix it again.

On Wednesday, for the first time in the history of the state, GPs will protest. They will not march, they will wear business or smart-casual clothes and stethoscopes, there will be no chanting and only black umbrellas are allowed if it rains. It will be dignified and, you sense, reluctant. But GPs feel their profession is in crisis, at breaking point. All the usual phrases we associate with our health system now in this resurgent economy.

And meanwhile we have been focused on pie-in-the-sky notions about universal health insurance for people who can afford their own health insurance and free GP care for people who can afford to go to the doctor. There is carnage at the front line and kids with severe illnesses and disabilities were having their medical cards taken off them, and these were the big ideas in health.

Leo Varadkar, it has to be said, doesn't seem to have his head in the clouds. Varadkar has got a certain amount of stick, not least from his boss, for pulling back on some of this Government's health plans, but it seems he is doing that in order to focus on the basics of making the existing health system work before we build a new impossible dream.

The moment of truth for Varadkar, and in a way for this Government, will happen over the next few weeks. Ivan Yates, who is usually canny enough about seeing what's really bubbling under the noise of political reportage, says that this next election could be a referendum on health. Not that outlandish a thought when you consider that the last election was basically a referendum on discretionary medical cards, when the Government proved itself completely out of touch with the people in matters of humanity.

Faced with this new moment of destiny, the Government seems divided on health policy.

Varadkar is making no bones about what he thinks needs to happen. Health, he thinks, should be a concern for the whole Cabinet, for all of us. Varadkar wants to go back to fixing the boring nuts-and-bolts, doctorish kind of stuff. But to do this, he wants more than a billion quid, what he calls a realistic budget, presumably in contrast to the makey-uppy ones that his predecessor would agree to with seemingly no intention of keeping to it. The €1.4bn extra that is being bandied about includes €200m for what is called "demographic pressure", which is presumably a euphemism for more old people living longer, and then €200m for new services. So that's a billion more just to keep the ship afloat, a ship that everyone involved agrees is in complete crisis.

Brendan Howlin, on the other hand, apparently wants Leo to take a cut of €250m in his budget, but is thought to be considering some kind of compromise. When you look at the other two big spending departments, you have to think €250m is a bit harsh. Social Welfare needs to cut €220m from its budget, but much of that will presumably be made up by more people coming off the dole. Education is to cut a mere €39m.

Even with the economy taking off like Noonan's proverbial rocket, and a neutral budget in the offing, Brendan Howlin keeps stressing to all his colleagues there isn't money to burn. And let's face it, the Government presumably needs whatever money it has to spare to give people the tax cuts they've been promising us for the last while. It's getting closer to election time after all and people have endured a lot of pain and they need to feel the jingle of a few quid in their pocket. Then again, they were giving us tax cuts when they thought growth was only going to be 3pc, which was just a week ago. Now Noonan has revised this year's estimate up to 4.5pc, a staggering increase of 50pc, and he will be revising upwards for 10 years after that too. So maybe we have extra wriggle room for Health now.

Here is a curveball to throw into the mix. Is the health service now in such a dire state and have so many people experienced this first hand or through a loved one, that they would rather Health got fixed than get the fiver or tenner extra in their pocket every week that Leo talked about? Or are we willing to make further cuts to our health system in order to facilitate tax cuts?

Our poll today shows that people are more receptive to using our growth bonus to improve services than the Government might think. We asked "If the Government was to give something back to the people in the Budget, which of the following would you prefer that they did first?" The most popular choice was to increase spending on health, education and social services, with 32pc of people opting for that. Admittedly, 29pc wanted a cut in the USC and 27pc wanted tax bands changed. But nonetheless, 32pc of people choosing society over their own pockets is something to work with. It demonstrates again, as the medical card issue did, that we tend to underestimate how altruistic and humane people can be.

The worry people would have about giving more money to health is that Health can seem like a bottomless pit and pouring more money into it can seem pointless. But maybe, with Leo, it could be different. Leo has this reputation as being a straight talker. People trust Leo insofar as they trust any politician. As with Joan and Labour, Leo gets a bye when people pour scorn on Fine Gael. And you have to think that if people would trust anyone with this money they would trust Leo.

So maybe there would be an appetite to give him a chance here. He has 18 months or so to steady the ship of Health. So what if Leo made a covenant with the people? What if we agreed to forgo a portion of the planned tax break this year and instead give the money to Health?

And what if Leo, in return for this, agreed to be completely open and transparent about his progress? What if Leo agreed to give an update every week on what was being achieved with the money, on how things were being fixed? And what if he agreed that he would admit when he wasn't making progress? How about this: Leo sets out his stall of what specifically he will do with an enlarged budget in the next year and then makes himself directly accountable to the people who gave him that money?

It's unorthodox, for sure, but then Leo is a rather unorthodox kind of politician. And nothing else seems to have worked so far. And meanwhile our broken health service continues to contribute greatly to the suffering and pain of hundreds of thousands of people in this country.

Enda Kenny says the prize is the future. And what he wants to do with the forthcoming Budget and the one after that is to strengthen that future. Surely a cornerstone of that future, maybe the very foundation of it, needs to be a functioning health service.

Sunday Independent

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