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Explainer: Why is Health Minister James Reilly under pressure?

The Minister has come in for considerable criticism and scrutiny in recent days but why is he under pressure and what’s likely to happen in the coming weeks and months?

Health Minister James Reilly (File photo)
Health Minister James Reilly (File photo)
Image: Mark Stedman/Photocall Ireland

THE HEALTH MINISTER James Reilly has come in for considerable criticism in recent months culminating in the two main opposition parties set to table motions of no confidence in him when the Dáil returns.

Though there was much speculation about the Fine Gael minister’s future over the weekend it appears unlikely he will be moved anytime soon and the motions of no confidence will be easily defeated by the government’s huge majority.

But that will not disguise the considerable unease that Reilly is causing particularly among backbench Labour TDs worried about the effect his surprise announcement of cuts in the HSE last week will have on the most vulnerable in our society.

But these are not the only reasons why Reilly is under pressure. TheJournal.ie looks at a few more…

Handling of the Health Service Executive (HSE)

Reilly was appointed Health Minister in February 2011 having spent two years in opposition promising to radically overhaul the delivery of health services in Ireland during his term in office. As part of this he pledged to abolish the HSE by incrementally reducing its involvement in the delivery of services following much criticism of the organisation.

He started that by asking the board to resign and then appointed a new board with more health professionals on it. Then in changes announced earlier this year which would see the post of chief executive abolished, Cathal Magee announced he was standing down. Reilly has also installed a structure that he described as ‘temporary in nature as the Government moves to introduce new legislation to establish a new directorate structure in the HSE’.

So as the HSE remains in place, it is the subject of considerable scrutiny particularly when it was revealed earlier this year that it was facing an overspend of some €500 million for 2012. That led to the announcement last week of an additional €130 million in cuts, some of which will hit the elderly and those with disabilities.

It’s not hard to see that such a decision would be unpopular but Reilly would rightfully argue that it is necessitated by the country’s dire economic state. But all that said, others would raise questions as to just why the hundreds of millions in overspend was allowed and not contained earlier and whether Reilly handled the announced cuts last week well given he was accused of “going into hiding” when it was left to the HSE’s Laverne McGuinness to answer questions on the €130 million cuts.

The extent of the problems in the HSE were underlined when details of the now departed Magee’s correspondence with Reilly about the HSE deficit were disclosed. Magee’s request for guidance from the Department of Health was met with a directive to find more savings from the reform of work practices, something which apparently hasn’t worked.

Dealing with consultants’ pay

Reilly has been accused of failing to address the issue of consultants’ pay in the health service, which the programme for government said would be reduced. However, the Minister argues that changes in work practices have yielded €63 million in savings last year and will yield another €70 million this year.

He has now raised the issue of Croke Park Agreement and the need to look at pay across the public sector which is currently protected under the agreement. But that is unlikely to sit well with unions and that’s a whole other problem…

Communication with unions

Although speeches to union conferences are rarely pleasant affairs for ministers, Reilly’s speech to the Irish Nurses and Midwives Organisation (INMO) in May did not go down particularly well as he told nurses that hospital beds that have been closed will not be reopened, and he outlined the neccessity of cuts and a change in work practices.

In response, INMO president Sheila Dickson said that her members did not need a lecture from a government minister while other delegates felt Reilly’s speech was too short and lacked substance.

Relationship with junior ministers

In July, the Minister of State for Primary Care Róisín Shortall was asked four times whether she had full confidence in Reilly as health minister and on all four occasions declined to say categorically that she did instead saying that the pair needed “to work through policy”.

The tensions have been underlined by the fact Reilly did not inform Shortall or fellow Labour junior minister at the Department, Kathleen Lynch, that Cathal Magee was to step down from the HSE. Both instead learned of the development through media reports, an indication of the strain between the ministers.

Children’s Hospital

In February, following the decision by An Bord Pleanála to refuse planning permission for the long planned National Children’s Hospital on the site of the Mater Hospital in Dublin, Reilly told an Oireachtas Committee: “We shall sit down and examine the decision…with great urgency and immediacy”. Seven months on and we are no closer to knowing just where the hospital is going to be built and when construction will begin.

Granted this is a fiasco that is leftover from the previous government but Reilly is sure to come under growing pressure in the months to come unless a decision is made as to just when and exactly where the much needed hospital is going to be built.

Personal issues

Reilly became the first cabinet minister to ever have his name published on the defaulters’ list in Stubbs Gazette in July. It caused some considerable embarrassment for the Minister who was forced to make a statement to the Dáil which many feel did not sufficiently address the issues raised by the publication of his name in the Gazette for his involvement in a nursing home in Carrick-on-Suir.

And it was that very home in Tipperary that was the subject of a critical report from the Health Information and Quality Authority in June.

In April of 2011, it was revealed that Reilly and his wife are the recepients of tax breaks for the upkeep of their 13-bedroom mansion in Moneygall, Co Offaly. Of course there is nothing at all wrong with this but it is unlikely to sit well with those who are on the receiving end of the health cuts to see the Minister responsible for overseeing them living in such a place and benefiting financially from it.

In addition to this, Reilly was one of a number of Fine Gael ministers who met with Michael Lowry, the controversial TD who was the subject of adverse findings in the Moriarty Tribunal report. Reilly defended the meeting as being in the interests of democracy but that did not stop a few raised eyebrows about his and his party’s continued relationship with a TD it ousted in the 90s.

Communication

By now you can probably see a theme developing when it comes to the Minister and explaining why he is under pressure.

Reilly has in various quarters been criticised for failing to communicate the changes he is implementing and plans to implement to the rest of the government and to the general public.

The resignation of Cathal Magee was significant enough without the accompanying fiasco of ministers in his own department only finding out through the media. Added to that why was the issue of the potential overspend of €500 million kept from government until it too emerged in the media?

And it is clear that was little in terms of communication about the €130 million in HSE cuts announced last week beyond an email a few hours beforehand, according to fellow Fine Gael minister Lucinda Creighton in the Irish Times today.

Last, but by no means least, Reilly has been praised in some quarters for his acknowledgement that the government needs to legislate for the landmark Supreme Court X case. But that has not stopped criticism from within his own party for appearing to set out his agenda on the issue without first consulting the views of those within Fine Gael who are vehemently opposed to legislating for abortion in Ireland in any way.

It’s clear communication is an issue for the Minister.

What’s going to happen…

There were no major developments from today’s cabinet meeting to indicate that Reilly’s position is in jeopardy, added to that a number of Labour backbenchers who raised concerns about the Minister over the weekend have since softened the tone of their rhetoric.

Reilly will survive the obvious embarrassment that will be cause by the tabling of motions of no confidence by opposition parties. But how he will resolve the ongoing financial problems in the HSE and deal with the considerable opposition the forthcoming budget cuts in the health sector are likely to create is more difficult to determine.

And while dealing with all of this what impact will it have on his long held ambition to reform the delivery of health services in Ireland by creating Universal Health Insurance?

It’s little wonder that one former health minister, Brian Cowen, once referred to the Department of Health as ‘Angola’ because it is full of unexploded mines.

Read: Unhappy Labour backbenchers to stand by Reilly, call FF motion a ‘deflection’

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About the author:

Hugh O'Connell

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