Reilly/Shortall rift exposes contradiction at heart of Government
If Roisín Shortall stands her ground it will create a political problem for Labour of far greater significance than the issues relating to health service reform. By Eoin Ó Broin.
The very public row between Minister for Health James Reilly and Minister of State with responsibility for Primary Care Roisín Shortall is about more than personalities. It is also about more than decision-making processes and policy choices within the Department of Health.
At the heart of the conflict lies a contradiction that runs not only though the Department of Health but the Programme for Government and the Labour Fine Gael coalition. While Minister Shortall is likely to be the first casualty of this contradiction, the Labour Party and even the Government could become its ultimate victims.
The Programme for Government agreed between Fine Gael and Labour in March 2011 had two defining features. On the one hand the Programme accepted the macro economic and fiscal framework of the outgoing government as outlined in both the National Recovery Programme and the Troika Memorandum of Understanding. On the other hand the Programme committed the coalition to a series of far-reaching political and public service reforms. Nowhere was the promise of reform more ambitious than in the area of health.
The coalition claimed to be "the first government in this history of the State that is committed to developing a universal, single-tier health service." The Programme for Government guaranteed "access to medical care based on need, not income". It promised to introduce "equal access to care for all" via a Universal Health Insurance system "designed according to the European principle of social solidarity".
With Labour and Fine Gael in office the days of Fianna Fail’s "unfair, unequal and inefficient two-tier health system" were apparently numbered.
The health section of the Programme for Government was clearly a big win for Labour. They had invested significant energy in developing their own universal social insurance model while in opposition. Now, despite a few concessions to Fine Gael’s preference for private insurance, both the values and the policies of Labour were to guide a transformation of the health service.
How such a transformation was to be achieved alongside a recruitment embargo and significant reductions in health expenditure was never explained. €2.5bn has been taken out of the health budget in the last three years and staff numbers reduced by 8,000. More than €1bn is due to be cut from health spending over the next three years alongside further reductions in staff.
Meanwhile the spiralling cost of health insurance, rising levels of unemployment, financial hardship and emotional stress are all pushing up the cost of public health provision.
How anybody thinks it is possible to radically transform the health service in the context of rapidly reducing resources and ever increasing levels of need is hard to understand. As the Government approaches its second year in office the progress of its ‘reform agenda’ across all the portfolios, including health, is poor to say the least.
This is the context in which Roisín Shortall’s contribution to the no confidence motion debate in the Dáil last week must be read.
Clearly Shortall is frustrated by the way in which James Reilly is running the Department. There is also growing evidence of significant differences of opinion between Reilly and Shortall on how best to progress specific policy matters. However one can’t help feeling that the target of Shortall’s frustration is fundamentally misplaced.
In her Dáil speech last week Minister Shortall listed a series of choices facing the Government such as increasing prescription charges for medical card holders and cutting home helps or capping consultants pay and reducing the drugs Bill. She argued, rightly, that "we cannot cut our way out of problems" and that reform must be made "in the best interests of patents."
Yet she seemed completely unaware of the contradiction at the heart of, not only Government health policy, but the Programme for Government itself and with it the Fine Gael Labour coalition.
Minister Shortall told the Dáil during the no confidence debate that without "substantial reform there will be cuts and the poor will be hardest hit". Is she seriously suggesting that the spending cuts and staff reductions imposed by Fine Gael and Labour since March 2011 are not already hitting the poorest hardest?
Minister Shortall is clearly making a stand, both for Labour Party health policy and for the commitments entered into in the Programme for Government. For that she should be commended. But in the end her stand will be in vain if she fails to understand that the promise of reform agreed will always be undermined by the macro-economic and fiscal policies being pursued by her government. So long as Fine Gael is allowed to determine economic policy real reform of our public services will be impossible.
It is not surprising that there has been little evidence of support for Minister Shortall’s stand from her Labour Party colleagues, whether in cabinet or the backbenches. In challenging James Reilly she is not only taking on her senior minister but a close political ally of Enda Kenny.
But her real problem is far greater. He stand, no matter how unwittingly, has exposed the fundamental dishonesty that lies at the heart of the current government. The policies of austerity and unlimited bank bailouts are simply not compatible with the policies of investment in universal public service provision and social and economic recovery. The kind of equality that Roisin Shortall is arguing for in health policy cannot be achieved in the context of an economic policy that increases inequality.
Roisín Shortall is a good politician and would certainly make a better Minister for Health than James Reilly; but not in this government. If she stands her ground it will create a political problem for Labour of far greater significance than the issues relating to health service reform. If she retreats, or if her party sacrifices her in the interests of government stability, it will demonstrate beyond any doubt that Labour’s function is to do little more than make up the numbers in a government even more reactionary than its predecessor.
Eoin Ó Broin is a political activist, writer and member of Sinn Féin.