Tuesday 21 May 2019

A frail government, whose ministers tip-toe round Independents - but it might just deliver on health

Chief Whip Regina Doherty will have her work cut out in the current Dáil Photo: Tom Burke
Chief Whip Regina Doherty will have her work cut out in the current Dáil Photo: Tom Burke

Liz O'Donnell

The Government's fragility was revealed once again this week when it lost a Dáil vote. Fianna Fáil supported a Labour Party private members motion on workers' rights. The numbers are such that every day has the potential for discord and defeat.

As Minister for Public Service Reform Paschal Donohoe conceded last week on radio: "Ministers have to win arguments before they win votes in this Dáil." No piece of legislation or policy initiative has the luxury of passage just because it has the support of the Cabinet.

It must be galling for ministers. A key aspect of ministerial office is to be constitutionally bestowed with executive power by virtue of being a member of Cabinet. It is an empowering privilege to be in control of one's area of responsibility; to be in a position to initiate reforms, implement policies in line with one's party position and ideology, and establish a familiarity with and competence in the management of a government department.

But this batch of ministers operate in a permanent state of insecurity, tip-toeing around the sensitivities of Independent Cabinet colleagues, some of whom are by their nature unreliable, and endlessly compromising with Fianna Fáil.

Whatever about keeping Fianna Fáil sweet, a tougher challenge is placating the Independents. In a few short weeks, there have been near misses, with Finian McGrath and John Halligan having wobbles on water charges and Michael Harty adopting a case-by-case approach to supporting the Government. Then there was the Government cave-in on the controversial Central Bank interest rates legislation put forward by Fianna Fáil.

Government Whip Regina Doherty is an impressive minister, but has her work cut out to ensure she has the numbers to pass legislation. Apparently, 'pairing arrangements' no longer apply. This was the time-honoured system whereby the whips of all the parties agreed in advance on the absences of ministers and of their deputies. It was a system based on trust and principled politics.

However, this week an email was sent out from the Whip's office to all ministers and ministers of State. Citing the "delicate voting situation", it warned that all ministerial engagements must be arranged outside Dáil sitting days. Ministers will have to seek permission a week in advance to be absent for a vote, but even then there is no guarantee. This is going to make life very difficult for ministers carrying out their ministerial functions, particularly in relation to EU business or engagements outside of Dublin.

Essentially, they are under a whip and confined to Leinster House, or nearby, when the Dáil is sitting. Even the Taoiseach is being called on to traipse down to the chamber for routine votes on the order of business, which is a gratuitous interference in the functioning of his office.

If this is part of the new politics, it is not a progressive or practical development. I would have expected facilitating pairing arrangements to have been covered by the Fianna Fáil/Fine Gael confidence and supply deal. Instead, the protracted negotiations concentrated on Irish Water and other issues aimed at extracting maximum concessions on key policy positions.

Whatever their private feelings, there is a marked conciliatory approach from Fine Gael ministers when interviewed in the media, a sign they accept the new restrictive terms under which they must operate. Ministers in key areas such as Health, Housing and Public Expenditure and Reform are displaying masterful diplomacy even under intense media interrogation.

And it may be the case that some goodwill come from the forced collectivism in the Dáil. The new budgetary committee proposed in the Programme for Government will share some of the responsibility for budgetary proposals and choices with the Opposition; an experiment that will be interesting to observe in practice.

Health Minister Simon Harris could be said to be making a virtue out of necessity by embracing the whole Oireachtas in the new special health committee, which is tasked with planning long-term for a better health service.

Different ideologies and vested interests in the health sector have over the years contributed to the status quo, which is a disappointing failure on many fronts. There are 500,000 people on waiting lists, staff shortages and a permanent crisis in emergency departments.

The new all-party special committee of 14 members, only four of whom will be Government TDs, is being set up to plan for a "singular vision for the health service over the next 10 years".

Mr Harris declared that, when it came to health policy, the new Dáil is "diverse, but it need not be divided". He was generous in crediting Social Democrat TD Róisín Shortall with the idea of reaching consensus on designing a universal single-tier health system and funding model, in which care is received on the basis of need rather than ability to pay.

It is a tall order. But given the powerful vested interests in the health sector who resist reforms, consensus rather than ideology may finally liberate health policy from the ad hoc politicking that has brought us to the current dysfunction. For too long, health policy has been a battering ram used against successive governments. Scandals and cover-ups, abuse in care centres, people languishing on trolleys, waiting lists, misdiagnosis of cancer patients, unexplained baby deaths and inequality of access to therapies have provided great fodder for Opposition parties over the years. Attempts at structural reform by successive ministers always failed. Public discontent with the state of the health service was a major cause of the unpopularity of the last government.

The escalating cost of treatments is also a concern, with people living longer and higher public expectations. The cost of life-saving drugs and the decision-making and economics around availability dominated the airwaves this week, generating political pressure and understandable emotion. Such issues are best resolved in the context of a planned and agreed funding model for the delivery of a world-class health service.

So, despite the many challenges and frailties of the minority Government, this fractured Dáil may deliver significant health reform. The committee is due to report back with an agreed strategy in six months. It's an ambitious timeline - and time is not on the side of this Government.

Irish Independent

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