Reilly Shortall Rift Exposes Contradiction at Heart of Government

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The very public row between Minister for Health James Reilly and Minister of State with responsibility for Primary Care Roisin 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.’
Now that Labour and Fine Gael were 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 Roisin 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 difference 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 help 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 patients.’

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. Her 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.

Roisin 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 little more than making up the numbers in a government even more reactionary than its predecessor.

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One Response

  1. D

    September 26, 2012 4:42 pm

    Eoin, a good piece. But that being the case, surely you must think about your own party’s behaviour up north. The party seems completely ignorant of the even more grievous contradiction between speaking on one side against Tory Austerity and even flying the flag at anti-cuts rallies yet wilfully implementing it in partnership with the DUP and the others in Stormont on the other. The party talks about the right of ‘Education for All’ and there was the radical education policy written ‘Educate That You May be Free’ but then your Ministers are signing off on policies which will see Educational Maintenance Allowance slashed – when that allowance is essential to enable children from low-income households to stay in education to A-Level. Sinn Fein Ministers for Education are today signing off on rural school closures which will force children to travel to schools increasingly concentrated in hubs and will be detrimental the quality of life of local communities (many of which are trying to fight the cuts). And the same thing is being replicated across Department after Department.
    Personally, I don’t think that the party is innocent of that contradiction, any more than I believe that Labour are unaware of their own. But even more glaring is the contradiction between what Sinn Fein in government north of the border are doing compared to what Sinn Fein in opposition, south of the border, are saying.
    Therefore, there are some obvious questions to ask given the fact that it would appear that Sinn Fein will likely make up at least the junior partner in the next coalition government. Is it reasonable to consider that the same leadership who sees fit on strategic terms to implement austerity in the north (justified on the grounds of hands being bound by the Treasury budget dictating reduced public expenditure) will not see fit on strategic terms to implement austerity in the south (justified on the grounds of hands being bound by the Troika budget dictating reduced public expenditure)? Is it not reasonable that those who have displayed a strength of leadership in demanding its support-base north of the border be willing to do the uncomfortable thing in terms of engaging with Unionists will not display an equal strength of leadership in demanding its support-base south of the border be willing to do the uncomfortable thing in terms of implementing ‘real-politik’ cuts as a means of advancing national reunification? I believe it is clear which way the party would go. Let us remember that its instinct in September 2008 was to back the bank bailout as necessary and responsible (noting the handful of honourable exceptions – yourself foremost – who publicly opposed the move) – only afterwards did it realise that it could easily adopt an oppositional position (compare this to Labour’s instinct – which was, if anything, more sharp in its political opportunism). Doesn’t it seem natural that the dramatic changes that are clear to anyone watching the party closely north of the border in terms of its activist base over the past 5 (particularly 2) years will be replicated in the south as it comes in out of the cold into government. The party’s success in the current political set-up demands nothing less – it is the logical outcome of its strategy which is to drive (manage?) change from the top-down. To think otherwise is to fool yourself.
    It appears clear to external observers that the current positions of people like yourself – who are clearly honest and who appear to be blind to all this – are merely being used by those who have a different strategic agenda. Your oppositional politics is realpolitik for now but the same decisive organisational strength which was displayed in delivering peace and participation in Stormont against strong internal opposition on the ground will no doubt deliver reasonable policies in a Dublin Government in the face of weaker opposition.
    So we are left with ironies such as Sinn Fein Ministers who have no problem today implementing a wealth of Private-Finance Initiative contracts throughout Departments in the north at the very moment when even the Tories in Westminster are reviewing PFI deals on the basis that they are delivering poor ‘value-for-money’! Or the fact that at the very same time that Sinn Fein in Dublin are arguing vociferously (and correctly) against a two-tier health system (and rightfully exposing Labour’s duplicity on this issue), Sinn Fein Health Ministers in the north have signed off on lucrative contracts into the hundreds of millions for private sector (banks!) built, maintained and owned hospitals where visitors will be charged parking fees, wings are dedicated to the provision of private sector consultants and low-paid security and porter workers are transferred to private sector operators to suffer further .
    Isn’t it a case that your attacks on Labour are a classic case of seeing others failures but being blind to your own?