Looks like a good idea — so let’s smother it

The good news: politicians have done useful work on health. The bad news: it’s about to be banjaxed, writes Gene Kerrigan

LAST week, The Sun, in a large front page headline related to Brexit, called Taoiseach Leo Varadkar an “airhead”. The story was a distortion of the facts. The headline was not just insulting, it was untrue.

I’ve known more than one politician who rose to the rank of minister despite possessing the brainpower of a bale of briquettes. Leo Varadkar, however, is not such a politician.

Leo Varadkar passed all the exams required to qualify as a doctor, which suggests there’s more inside his skull than air and cotton wool. There have, on the other hand, been editors of The Sun who couldn’t spell doctor (a couple of them came close, but they couldn’t figure out where to put the ‘k’).

No, our Taoiseach doesn’t suffer from a lack of intelligence. He suffers from a surplus of ideological extremism.

And, according to media reports last week, Varadkar is about to heap further damage on those of us likely to need health treatment in the next decade or two. Which means, pretty much all of us.

It’s now 12 years and four months since Minister for Health Mary Harney declared a national emergency in A&E services. The emergency continues, with the figures much worse today.

Estimates based on research done elsewhere suggest about 300 lives a year are lost because of the A&E chaos.

The lesson in all this is clear: for the foreseeable future, you should not allow yourself to need emergency treatment.

And, given the hospital waiting lists, try not to need ordinary, non-emergency treatment, either.

Some among us will die on hospital waiting lists, many others will linger in pain and disability that could easily be relieved. Some people will be on waiting lists so long that relatively minor medical problems will develop into major ones.

Some of this pain, some of this crippling disability, some of these deaths, are unavoidable. But political choices will now, and in years to come, prolong pain and disability that could be treated. And cause deaths that could be avoided.

This will happen to you; or a relative; perhaps your child, perhaps a friend, perhaps all of these.

And another 12 years and four months from now the public health service will be worse, unless we do something about it.

Public health services do not “get” better. They are made better.

The good news is that politicians have been busy trying to mend this broken system. Fair play to them. A cross-party group was formed more than two years ago, as part of the Programme for Government. They worked hard and, by all accounts, they worked cooperatively.

In May of last year they published a proposal for health reform. They called it Slaintecare. It outlines a complete overhaul of the public health service.

Some people think it’s an excellent report, some think it too conservative. I suspect it’s the best proposal that could be got through a group that includes representatives from all the political parties.

Certainly, we cannot continue with these perpetual emergencies, with all the dreadful personal horror stories they create.

Slaintecare isn’t a quick fix. It will take 10 years and it needs €3bn in transition costs over that period.

The committee of politicians worked quickly. They proposed an implementation group that would draw up “a first draft of the detailed implementation project plan”. This was to be published by the end of 2017.

First, though, the Cabinet had to give it the once-over.

Ahh, sure, what’s the hurry?

Into 2018 we went, with the Government giving Slaintecare the old “any day now” treatment, missing one deadline after another.

Finally, last Wednesday, Simon Harris brought the proposed implementation plan to Cabinet. It was treated with all the loving attention the average Sun editor lavishes on an antiBrexit politician.

Varadkar moaned about costs. Implementation, he whined, “is going to be difficult”. Eh, yes, Leo, no one doubts that. Fixing the chaos caused by decades of neglect is never easy.

It will, though, Varadkar said, proceed at “a slower pace than maybe people would like”.

That’s that, then. Slaintecare, a good idea while it lasted.

Good ideas are easily smothered. You slow things down, claim costs are unsustainable, eventually the good idea becomes a drag on the system. When it expires, no one notices.

Once upon a time we had a Minister for Health called Micheal Martin (whatever happened to him?)

He had great reform plans. He would end hospital waiting lists within two years, he said. His plan would add about 300 beds a year to the system, for 10 years. By 2011, we’d have an additional 3,000 badly needed beds.

Not a chance, said the Department of Finance. We could afford Charlie McCreevy’s tax cuts, but not enough hospital beds to treat us.

Had that reform gone ahead, we would have been spared much of the pain of these 12 years of national emergency.

And the system would be more efficient and less costly to run.

Today, the crippled health system costs an absolute fortune — just to keep it going, with all its patches and emergency measures.

The day after Varadkar let us know that we can’t afford Slaintecare, his words seeped into media reports, the language of the hatchetslashers from Finance.

“Escalating expenditure... spending would have to be controlled... could not be sustained...”

The buzz word is “overspending”, by €680m.

There is no evidence of overspending.

An “overspend” is when you decide to have scalpels made of solid gold, and bandages made from Egyptian linen with a thread count of no less than 1000psi. An “overspend” is when you spend more money than you need to.

When you need to spend €680m more than was budgeted for, it means the people preparing the budget underestimated the costs. And this happens all the time, as Finance tries to push departments into cost-cuts.

The health system has been historically underfinanced. We pay for the under-budgeting in treatment delays, in pain, in eyes with cataracts that prevent us watching TV, so we can’t see those lovely shots of smiley Leo being smarmy all over Mr Trump.

And we pay for it when we die prematurely, because some politicians are complacent about presiding over an “emergency” that’s lasted 12 years, with no sign of hope.

Slaintecare was designed to end the perpetual emergencies and the everescalating costs, by replacing a patchwork system with one designed for our needs. The transition cannot be — and was never designed to be — financed out of the normal costs of running the current wretched, overstretched system.

Slaintecare is not an NHS, but it’s a step too far for the ideologically pure devotees of the free market.

We’d be better off if Leo Varadkar was indeed an airhead. If he was as thick as the average editor of The Sun, he’d be happy to get the kudos of implementing a plan on which others had done the hard work.

Instead, with a headful of politically correct notions, aware that Slaintecare is someone else’s idea, and having been Minister for Health without doing anything to end the horrors, he quietly murmurs: “Eh, it’ll take some, eh, time.”

If Micheal Martin threatened to resign in 2002, would FF have rallied around him? If Simon Harris did the same now...

Oh, sorry, I dropped off there, for a moment, had a dream about politicians who were in it for what they could achieve.

‘Politicians are complacent about presiding over an emergency that’s lasted 12 years’