Bill Clinton says there are only three things that should matter to public servants in their work: “Are people better off when you quit than when you started? Do children have a brighter future? Are things coming apart or coming together?”
Consider the answers to these questions in the context of James Reilly's tenure as Minister for Health. While the former GP and IMO leader will no doubt claim to have done a good job in difficult circumstances, it's a fair bet that most neutral observers would give his performance the thumbs-down.
Reilly failed to make a serious dent in waiting lists, apart perhaps from trolley waits, and failed to convince ordinary people that the health service was getting better. Even though there were improvements, in areas such as cancer and cardiac services, with a resulting increase in life expectancy, the perception under Reilly's reign was of a health service that was falling apart.
Sense of drift
The sense of drift grew by the day, as the Minister was ignored or overruled by fellow Cabinet members, and it often seemed like there was no one in charge.
Stopping this drift, restoring staff morale and regaining public confidence will be among the first priorities for his successor, Leo Varadkar.
Meanwhile, Reilly, now Minister for Children, is left to ponder what might have been. Having always insisted health was the only ministerial job he wanted, he now has to make do with a lesser ministry, albeit one that still commands a seat at the Cabinet table.
Reilly, relatively new to politics and Fine Gael, was regarded as a loose cannon at the start of this administration, and he quickly fulfilled the low expectations of him from the start.
The fact that he has survived while the Government’s other loose cannon, Alan Shatter, was forced to resign from Cabinet will serve as little comfort.
The truth is that Reilly should have gone over two years ago, when his efforts to prioritise the building of primary care centres in two sites in his own constituency were exposed in this newspaper.
Parish-pump politics
This grubby exercise in parish-pump politics set the tone for the Government as a whole, by confounding its promises to deliver a new type of politics.
That Reilly wasn’t sacked probably has most to do with the fact that other ministers were deeply implicated in this dubious decision.
The perception of Reilly as a politician with more than an eye on local needs has persisted, with further controversies over the allocation of Lottery grants and autism services to north Dublin.
He did little to enhance the status of his office by becoming the first minister in the history of the State to be named in Stubbs Gazette over an unpaid business debt, one that remains unpaid to this day. His fellow Cabinet ministers barely blinked.
The direct outcome of the primary care centre row was the resignation not of Reilly but of his Labour junior minister, Róisín Shortall, with whom he was already having a difficult relationship.
Reilly, and his Government, plumbed the depths of popularity in the opinion poll, and he remained as the Cabinet’s most unpopular minister for the duration of his three years in office.
Independent Senator John Crown said last week that Reilly had drawn “an unlucky hand” through his appointment as Minister at a time of unprecedented cost-cutting. Over €3 billion has been lopped off the health budget since 2008, and each year since he came to power in 2011 Reilly has been required to reduce spending by hundreds of millions of euro and often he has been blamed for decisions forced upon him by the rest of Cabinet.
As we well know, the health service consistently failed to reach these targets, although spending in raw terms has come down. This year, for example, the Health Service Executive is heading for an overspend of up to €500 million.
Much of this overrun is beyond the control of the health service, though often it occurs because Reilly’s department has been slow to introduce the legislation required.
As a proportion of an overall budget of €13 million a year, it isn’t enormous.
However, it’s the persistent failure to set a target and then stick to it that has the Department of Public Expenditure and outside observers worried. Through a lack of computer infrastructure, the HSE simply doesn’t know what its many elements are spending at any particular time, so by the time managers realise what is happening, it is too late.
Reilly came to office with a large vision ill-suited to the straitened times, and he did score some successes. He has made a dent in the trolley figures in hospital emergency departments, though comparing present-day numbers to those recorded in the freezing winters of a few years ago gives a misleading impression.
Improvements
The clinical directorate structure is up and running well, and there have been big improvements in cancer and stroke outcomes.
Reilly has shown courage in taking on the tobacco industry against ferocious lobbying; it remains to be seen if the Minister’s plain packaging legislation will survive his departure. He had less success combating alcohol abuse, where one of the main sceptics in Cabinet on the issue of restricting drinks industry sponsorship was his successor, Leo Varadkar.
So low has Reilly’s stock been that few people attach much credence to his main political objective – the introduction of universal health insurance in a second term of government. Few had a clear understanding of what the Minister was proposing, and even fewer thought it would ever come to pass. The fact that so many of the interim deadlines have been missed hasn’t helped.
Leo Varadkar will have to decide now whether to press on with this ill-understood and unpopular policy, and to give it prominence in Fine Gael’s manifesto for the next election, or whether to let it quietly wither on the vine.
