Hobson’s choice for Reilly – stay in Angola or shift to the backbenches

World of Politics with Harry McGee – harrymcgee@gmail.com

Brian Cowen coined the phrase ‘Angola’ to describe the Department of Health when he became the minister there in the 1997 – because, politically, this huge sprawling hard-to-control department was full of landmines.

You still hear Angola being repeated from time to time – but mostly to describe claimed third world conditions in our health services.

There is no other department that is as tough or has an equal attrition rate on its ministers. Michael Noonan was there in the 1990s and his and his department’s poor handling of the Brigid McCole case blighted his subsequent short leadership of Fine Gael. Mrs McCole was a woman who contracted Hepatitis C from a contaminated blood product. The Department fought tooth and nail – and in a very legalistic fashion – in defending itself in court against her. She died before the proceeding could come to an end.

Mícheál Martin was also there for almost five years and had a mixed innings. He created the Health Services Executive replacing the old health boards, such as the Western Health Board. But the problem was that merging all these organisations into one led to huge duplication and overlap.

The result was a terrible fudge – eleven health boards with different set-ups and different ways of doing things (and different emphases of service) coming together to create an ungainly, inflexible and unwieldy behemoth.

One of the big controversies around that time was the introduction of the PPARS payroll system, which would replace the different systems that had been in operation in each health bord and bring some uniformity.

The difficulty was that not alone were the payroll systems different, employees at similar grades in different health boards had different take home pay, working conditions, holiday arrangement and hours, because of localised deals that had been made.

In the end, the cost of introducing PPARS assumed biblical proportions, running into hundreds of millions of euro before the Comptroller and Auditor General said stop.

Mary Harney went into the Department with an ambitious reform agenda. Her big long-term plan was to locate private hospitals on the grounds of public hospitals to create an unashamed genuine two-tier health system.

Some of her early innovations did work. The National Treatment Purchase Fund was designed to reduce waiting lists for non-emergency operations.

There were anomalies that sounded a little unjust. A person waiting for over a year or perhaps two years for a surgeon to perform a procedure on the public system could get seen by the same surgeon in short order if the NTPF crossed his palm with euro. Some patients were sent abroad.

It was costly but it worked.

Another major creation of Harney’s was the Health Information Quality Agency, under Dr Tracy Cooper, which has ensured qualitative improvements in the standards of care in hospitals.

The recent HIQA report about University Hospital Galway’s treatment of Savital Halappanavar when she was in its care is a case in point. It was explicit and comprehensive in outlining the litany of shortcomings evident in UHG.

Despite a promising start, it became increasingly obvious that faced with the massive challenges in health, Harney had lost appetite.

For more, read this week’s Connacht Tribune.