Against: Liz O’Malley
For: Despite his medical background, James Reilly has under-performed as Health Minister, says David Reddy
The current Irish government and specifically the Health Minister James Reilly, through austerity measures and ill-conceived policies, are further damaging the nation’s health.
The EU-IMF bailout of 2010 heralded unprecedented government cost saving measures and the troika’s demand for cuts in health spending has pushed the health system to the brink of collapse.
There is little doubt that the HSE is in dire need of reform; however, Dr Reilly’s ambitious plan for a complete overhaul of the healthcare system coupled with a government who have refused to stand up to the troika on the subject of health spending cuts, means that the much needed reforms are failing to materialise and the healthcare crisis is deepening.
Despite Dr Reilly’s claim that “reform of the health service is progressing”, analysis suggests that aspects of the reform programmes are stagnating while others are increasing the level of inequality in the system.
Such programmes include the Universal Hospital Care initiative. This initiative aims to create a single tier health system and to provide reductions in the cost of providing public and private health care. At the halfway point of the government’s reform plan, it is clear that the programme’s objective of providing equality has yet to bear fruition and the health system is now more unequal then ever.
Several factors have contributed to the perpetuation of inequality. The reduction of tax relief on health insurance produced by last October’s budget, a government increase in stamp duty and Dr Reilly’s ambition of increasing private patient fees are set to inflate insurance premiums. Deloitte estimates that this will cost insurance firms €115.5 million, a figure which will lead to a predicted rise of 15% per subscription.
The Special Delivery Unit, whose purpose is to reduce waiting lists, is also failing along with Dr Reilly’s assertion that 12 month waiting lists would be eradicated by the end of 2013. Figures from the Department of Health for September 2013 highlight that 8,125 children are currently on outpatient waiting lists of one to four years.
As the empirical evidence points to a lack of progress concerning reform of the health system, Dr Reilly’s term has also been blighted with scandals that have raised questions over his suitability for the position of Minister for Health.
In July 2012, Dr Reilly was part of a group who defaulted on a €1.9m debt accrued from a failed nursing home venture. The incident calls into question Dr Reilly’s eligibility to manage the massive debts amassed by the HSE.
Health budget overspend became a constant area of contention between the troika and the government during the bailout and the department’s wasteful use of funds appears to be continuing. Presently, the cost of the new Children’s Hospital totals €41m. A figure generated with work not yet begun and completion not expected until 2018.
October 2012 heralded yet another scandal that engulfed the minister. On this occasion he was accused of adding two towns located in his constituency to a list of locations for primary care centres.
Dr Reilly’s actions are an unseemly example of stroke politics. Of course stroke politics are nothing new to the Irish political landscape, but the Reilly case raises serious questions.
So what does 2014 hold for the health system? The 2014 National Service Plan provides grim reading. The HSE will cut a further 3,600 whole time equivalents in 2014 and there is still €108 million unspecified pay savings to be accounted for.
The nation’s mental health is also under threat. The financial burden generated by cutbacks to medical cards and prescription prices will add further pressure to households already feeling the squeeze due to the recession.
From 2011 onwards, there has been a battle between the austerity measures of the troika and the reform needs of the health service. At the centre is the health minister who has lurched from one scandal to the next. It is a conflict that is set to continue for the foreseeable future and its biggest casualty will continue to be the physical and mental health of the nation.
It is true that, even with the required fiscal package, implementing Universal Primary Care in two and a half years was an unattainable goal. This begs the question, was the government correct to pursue a complete reform of the health system with the level of austerity demanded by the troika?
The reduction of people waiting on trolleys from 2011 to 2012 has been touted as a success, but the latest statistics show a renewed increase. The 2012 to 2013 figures from the Trolley and Ward Watch Analysis show a 2% increase in the number of additional patients on beds, trolleys or chairs above the official number attributed to the ward.
To say Minister Reilly’s reforms are being implemented in an equitable way is simply untrue. Cuts that target the most vulnerable sections of society are a testament to this.
The government’s much-hyped plan for free GP care for children under the age of six will come at the expense of infants and the elderly. 35,000 people over 70 years of age will lose their medical cards and prescription charges are set to rake in another €43 million. This will be accompanied by a €32 cut in maternity payment.
It is apparent that all available evidence points to a further increase in the degree of inequality generated by the health minister’s reform manifesto.
Against: Arguing that the Dr James Reilly is doing the best it can considering the circumstances, Liz O’Malley asks if anyone else could do a better job
Ireland has many challenges ahead of it in the area of health. Our population is ageing, which presents a number of different issues. The strain on the economy has meant that more people require medical cards (now 40% of the country), and less people can afford private health insurance. Our population is growing, meaning we have more people to cater for with fewer resources.
This government also inherited the HSE (Health Service Executive) from Fianna Fáil, an authority that became synonymous with a culture of giving jobs to friends of politicians and a lack of transparency, as well as a dire economic situation.
Despite this, the numbers seem largely positive. We have the highest levels of self-rated good health in Europe. Death rates fell by 1.6% in the last year alone, with deaths from suicide down 10%. The length of hospital stays has fallen and the number of patients discharged on the same day has increased due to less invasive and ‘key-hole’ procedures.
Obviously having to cut the health budget by €3 billion was not going to be painless. However, many of the cuts to the health budget did not come from primary care facilities, but firstly, cutting the number of people working in the HSE, and secondly, reforming the state system for drug subsidisation.
Holders of medical cards only have to pay a nominal fee of €2.50 per item for medicines, which otherwise would be many times more expensive. The government have reduced the costs of providing this scheme by using more generic, instead of brand name drugs.
There has also been a firm commitment to reducing waiting lists, with a 98% decrease in the number of people who were required to wait more than nine months for inpatient or day procedures from 2012 to 2013. There was also a reduction in the number of people waiting on trolleys, down 24% from 2011 to 2012.
The main focus of Minister Reilly has been in preventative medicine. He has extended cervical cancer vaccine to all girls in secondary school. His initiative ‘Healthy Ireland’ focuses, among other things, on reducing smoking, obesity and alcohol consumption, all of which create avoidable costs to the health system.
Cuts and spending have been smart, partly because they really needed to be, unlike the days when it was easy just to throw money at the problem.
Amongst other things, the health department has also put forward opt-out system for organ donations, legislated for the X case and is trying to reform the HSE.
There have been delays and objectives that have been frustrated, but the groundwork is there to make a more equitable health system. For example, while the cost of health insurance has been steadily increasing over the last couple of years, the cost to consumers has remained steady ever since the government came into power.
The government is beginning to introduce Universal Primary Care, first by rolling out free GP care for children under 6. It is a move in the right direction.
When assessing whether this government has done a good job on health it is important to be realistic. The government inherited a bailout plan from the troika which it had to follow, or risk defaulting on its loans. Health is the second biggest spender in our budget and therefore there had to be cuts.
But despite having to cut billions from the health budget, the core services have stayed roughly the same, or have gotten better.
We may wish that the government had been able to roll out universal health care in two and a half years, but it would have been pretty much impossible, even if this government was fiscally able to do so. The question you need to ask yourself is whether it is likely anyone else could have done a better job.
Previous ministers Micheál Martin and Mary Harney found the ministry frustrating even when they weren’t short of resources, with both known for leaving sick people on trolleys, scandals involving x-rays that hadn’t even been viewed by a radiologist, and standing over a system drowning in vested interests.
Minister Reilly has gotten a lot of flak, but he is trying to reform the system in an equitable way and has come closer to doing it than anyone before him.
Firstly, a 2% increase in the number of people waiting on trolleys in the last few months pales in comparison to the fact that the number on trolleys has been cut in half overall since this Reilly took over the Health Department. The increase may be attributable to the fact that more people get sick at the end of the year as the weather gets worse.
Secondly, it is claimed that the cuts are inequitable, but the examples put forward do not primarily affect the poorest or the sickest people. For example, it makes sense to increase the costs for private rooms, rather than putting them on the 40% of people who currently hold a medical card.
A group of people over 70 are losing their medical cards, while still retaining free GP care, because they earn enough that they don’t require them. At a time when savings have to be made this makes sense.
There has also been a cut of €32 a week in maternity benefit, a payment given regardless of income. It will probably mean more to mothers that their young children will receive free GP care until the age of six.
It’s important to examine Minister Reilly’s actual job performance rather than putting forward personal attacks as evidence of something else.