... but Stephen Donnelly agrees better controls on spending are needed and asks ‘are we ready’ for a UK-style Covid inquiry?
STEPHEN Donnelly has acknowledged his Department of Health and Paschal Donohoe’s Department of Public Expenditure are ‘in tension’ with each other.
But it’s a somewhat more diplomatic characterisation of the relationship between the rival ministers which emerged in the wake of an explosive pre-Budget meeting.
Just days after the Budget, the Irish Mail on Sunday revealed how officials who attended the meeting told how the Fianna Fáil minister told his Fine Gael Cabinet colleague it was ‘insane’ not to agree to his request for €2bn in extra health spending.
Ultimately, though, Mr Donohoe rejected the request, and instead granted just €708m extra for existing services, bringing the total health budget to €22.5bn.
In an interview this week, Mr Donnelly outlined measures he believes will bring productivity and cost savings to the health service.
Others in Government characterise the move as an effort to end a ‘tit for tat war’ between the departments that has endured since the summer.
Yet Mr Donnelly stands by the health service’s central argument that more funding is necessary to maintain the level of services provided this year due to increased costs and demand.
His language is measured, but the Minister for Health is not backing down.
Speaking to the MoS in an interview at his office in the Miesian Plaza Health HQ, in Dublin, the Minister diplomatically insisted: ‘Paschal and I have a good working relationship. We always have had a good working relationship.’
He said of their tense pre-Budget meeting: ‘We brought different views to the table on the health budget, which you’d expect… It’d be a very unusual Budget discussion if the minister for spending the money and the Minister for Health held the same view.
‘My job is to cut the waiting lists, cut the trolley numbers, roll out new services for patients. My job is to give us a great healthcare service. And Paschal has to protect the public monies. Those two things are in tension with each other. And they should be in tension with each other.’
Mr Donnelly stressed this ‘tension’ is traditional. But he believes this year was a particular exception because of the financial impact soaring inflation has had on running the health service.
‘In this year, for example, there’s an overrun of about €1.5bn,’ he said. ‘At least two thirds of that and probably more were not the HSE’s fault in any way.
‘There’s nothing the agency can do about that; they have to continue to buy the medicines, they have to continue to treat patients and heat the hospitals.’
Adding to the fiscal pressures, Mr Donnelly said the health service is also treating more patients than ever.
‘Part of the inflationary effect was excess spending but it was also due to the increased patient activity.’
Despite the pressures, the Wicklow TD believes there have been successes.
Although the Irish Nurses and Midwives Organisation (INMO) has claimed otherwise, Mr Donnelly claimed ‘the trolley numbers are lower this year than last year’.
He further claimed ‘the waiting lists are lower this year than they were last year’, although he concedes drastic measures need to be introduced.
‘There needs to be better controls, needs to be better management information and the [HSE] CEO [Bernard Gloster], to his credit, and the board are fully on our message with this,’ he said.
As part of a move to improve relations with the spending department, Mr Donnelly will invite it to join two new groups he is establishing.
‘There’s two things I’m setting up and I’m inviting DPER [Department of Public Expenditure and Reform] onto both. I think it’s important they’re on both because we need to build the common understanding between health and DPER. And, quite frankly, there isn’t [understanding currently]. There’s quite a gap.’
To address the ‘gap’, Mr Donnelly is establishing an ‘external expert group’ – which will include officials from his department, the HSE and DPER – to examine the ‘future costs’ of healthcare, a forum where ‘we can all agree and disagree’.
The Minister said members of the group will agree a ‘common baseline’ on a ‘reasonable amount to be spending for the services that we have’.
He hopes there will also be agreement on what, ‘given inflation and demographics… is a reasonable amount of extra money the HSE needs each year just to stand still’.
Mr Donnelly will also establish a ‘Savings and Productivity Taskforce’, on which the DPER, the HSE and his department officials will attempt to end the cycle of argument, leaking and negative headlines.
Although he disagrees with some in Government who have characterised this as a ‘Congress of Vienna’ type permanent peace conference, his determination to establish both new bodies is indicative of the seriousness in which he views the damage caused by the public arguments.
Like many in the Irish political sphere, the Minister for Health has been closely watching the UK’s current Covid inquiry.
He appears fearful the anticipated Irish inquiry into the State’s
‘The two departments should be in tension’
response to the pandemic may run into similar confrontational territory as the British one, and that it could be short on meaningful achievement.
‘Are we up to doing a sombre, measured, balanced, thoughtful review as a nation, as an Oireachtas, as a media?’ he asked rhetorically.
‘Well, we’re going to find out. I don’t think we have a good track record on these things.’
He said lessons have already been learned about Ireland’s response to the Covid-19 emergency and are being acted upon.
He said: ‘[We must] upgrade your
public health doctors to consultants… invest in serious IT so that your outbreak management and your vaccine programme and your patient records and all of that are linked up.’
An upgraded IT system – which is in train – would also provide ‘proper real-time information at the level we didn’t have and really could have done with the last time’, he said.
Mr Donnelly also wants to harness AI technology here to combat future pandemics. ‘I want to see us try to deploy things like machine learning, AI, algorithms, air pattern recognition to outbreaks,’ he said.
‘The Australians did this last time, but we couldn’t because we didn’t have the IT systems.’
Defending his and the Government’s response to the Covid-19 public health emergency, Mr Donnelly said: ‘Obviously, every person who died is one too many, and Covid came at a real cost to an awful lot of people. But relative to other countries, Ireland did very well.
‘I would ring [World Health Organisation director] Mike Ryan from time to time and he would say, “We are pointing at you in Ireland quite a bit.”
‘And he said one of the reasons we’re pointing at you is because
‘The instinct of the nation was one of solidarity’
your national response – I don’t mean Government – but your response as a nation, has been very positive. And this is one of the big takeaways from me.
‘I don’t know how useful it [an inquiry] is, as a lesson learned. But my view is, for a person’s character, we really learn about ourselves when we’re under real pressure.
‘And as a nation, we were tested during Covid at a level we hadn’t been tested [before].
Minister Donnelly added: ‘And as a nation, we stood together. The instinct of the nation was one of solidarity.’