Two locations in Minister for Health James Reilly’s north Dublin constituency were added to a list of places chosen for primary care centres on the evening before they were announced by the Government, newly released documents reveal.
Further changes were made to the list including the addition of Ballaghaderreen, Co Roscommon, and Kilkenny just hours before the list of centres was announced as part of the Government’s stimulus package last July, the documents obtained under freedom of information show.
Last September, The Irish Times revealed that Swords and Balbriggan were added to the priority list announced by Dr Reilly as part of the stimulus package, despite the fact that they did not feature in a list of the top 30 locations drawn up by the HSE and his then minister of state, Róisín Shortall.
Swords, Balbriggan, Kilkenny and Ballaghaderreen all ranked outside the top 35 in the list of priority locations drawn up by Ms Shortall and HSE officials, which was weighted towards the most deprived areas of the country.
Swords ranked 130th in this list while Balbriggan ranked 44th. Ballaghaderreen, which was the subject of lobbying by two Government politicians, ranked 244th, while Kilkenny was ranked in 151st position.
The issue has proved hugely controversial for Dr Reilly and the Government ever since. Ms Shortall resigned in September and later described the addition of the two locations in north Dublin to her original list as “stroke politics”.
The documents reveal a flurry of last-minute changes in July after the Department of Public Expenditure and Reform (DPER) told the Department of Health for the first time that the locations would be published at the time of the stimulus announcement.
At that point, on July 16th, 33 locations were on the list. However, the Department of Health then drew up its “final list”. A memo sent to DPER at 8pm on that day – the day before the announcement – submitted a new list with Swords, Balbriggan and Oranmore added, and South Dublin removed.
The following day another memo from the Department of Health, marked “urgent – revisions”, stated that there were “changes to last night’s list”.
“There are now 36 locations. Ballaghaderreen is new . . . Kilkenny is new, Castlecomer is out, Oranmore is out,” the memo stated. It was sent at 11:55am, almost 1½ hours after that week’s Cabinet meeting started.
The documents do not show the rationale Dr Reilly employed in altering the original list, but the Minister has said he made his decisions based on a number of factors, including the likelihood of GP buy-in to the plans.
The official files also show that last month the secretary general of the Department of Health Ambrose McLoughlin asked its internal audit unit to “ascertain any connection that links the Minister and/or his four advisers in relation to the selection of the sites for the Balbriggan and Swords primary care centres”. This followed claims that a supporter of Dr Reilly owned the site of a proposed centre in Balbriggan.
Dr Reilly rejected any suggestion of impropriety in the selection of the site. He said this had nothing to do with him.
Fianna Fáil health spokesman Billy Kelleher said last night the new information posed serious questions for Dr Reilly and Tánaiste Eamon Gilmore. He said the Tánaiste told the Dáil there was documentation which could be sought under freedom of information on the background to Mr Reilly’s decision. Mr Kelleher said nowhere in documents released did this explanation exist. A spokesman for the Minister did not return calls last night.
SPENDING IN Sligo Regional Hospital continues to be €800,000-plus per month over its approved budget, according to the latest figures released by the HSE last night (Tuesday).
However, finances in the hospital improved marginally — by a fifth of one percent — during September.
Sligo Regional is now listed 13th in Ireland — from 119 centres — for rates of absenteeism. General support staff, nursing and management/admin are the grades identified.
St Johns Hospital is also showing a budget overrun in excess of 10% for the year.
The ‘shave back’ and savings in Sligo Regional Hospital helped contribute to a national picture which saw the HSE’s overall deficit for 2012 drop back to €399 million — it’s first drop.
Sligo Regional Hospital has spent €7.4 million more than its allocated budget in the first nine months of 2012, last night’s official statistics confirm.
The Hospital has now exceeded its annual budget by 10.5%, states the HSE Performance Report for September.
Statistics for Sligo Regional Hospital reveal that by September 30th it had spent €78.4 million of its entire 2012 budget of €92.3 million.
The budget allocated by the Department of Health for 2012 suggested that Sligo Regional Hospital should have been able to get by with €70.9 million between January 1st and September 30th.
In St John’s Hospital, the accumulated budget overrun for the year now stands at €1.3 million — a 10.2% overrun.
St Johns show heavy spending on agency costs for staff in medical/dental; it accounted for 23% of payroll costs in September.
The Minister for Health, Dr Reilly, has iterated all year that there will be no bail-out for HSE or hospitals running over budget.
The Government has been under some pressure from The Troika, which oversees Ireland’s bailout. It has criticised spending on health.
The Irish Times reports this morning that the Government has agreed “to comply by the end of the month with a request from the EU-IMF troika for a detailed plan to tackle the spending overrun in the health service.”
RTE has, however, offered a glimmer of hope; unexpended capital budgets in 2012 may be considered for reallocation to current-side budgets, the station’s Health Correspondent Fergal Bowers indicated last night on television.
Fianna Fáil’s Health spokesman Billy Kelleher separately predicted the Minister “will move to ‘shore up’ his budget failings by moving unspent money from his Department’s capital allocation to current spending.”
A nursing union leader, Liam Doran of the INMO, said that talk of budget overruns was ”an accountants exercise.” The original budget was wholly inadequate, he said.
Criticism of budget overrun was “unfair, misguided and unwarranted,” added Mr Doran, who praised staff for “heroic” efforts.
The leading Labour Party councillor in Sligo, Cllr Jim McGarry, has also queried in past fortnight whether Sligo Regional Hospital has been under funded by the Government. See SligoToday.ie 5/11/2012
No Specific Reference
There is no specific reference to Cregg House in the Performance Report released last night.
Page 40 deals with an update assessment titled: ”Service Arrangements and Grant Aid Agreements.”
It remains unclear if this section — unlikely — includes any reference to the ongoing impasse between the HSE and the Daughters of Wisdom at Cregg House.
The Performance Report states: ”….Of the 27 Non Acute Agencies in receipt of over €10 million in the non acute sector, 14 have completed, with the remainder all indicating that they will sign with the exception of a single provider.”
This single provider, adds the Report, ”is in negotiations on whether they will continue to provide services.”
The Report speaks of “cost containment issues,” in particular in HSE dealings with disability agencies.
The Daughters six months ago publicly highlighted an issue of under funding in a proposed renewal of its Service Level Agreement (SLA) and said they could not continue.
In the past two months the Daughters again re-stated their commitment to leave after 57 years but offered an extension to January to the HSE.
The Performance Reports provides the most up-to-date picture of what is happening at all levels inside Irish hospitals, community services and the HSE itself.
In comparison, the report released Monday by the Economic, Social and Research Institute (ESRI) — which assessed hospitals including Sligo Regional Hospital — refers only to 2011 and an historical analysis of data.
They Reports are released online each month after all data and commentary for the relevant month has first been sent to the Minister for Health.
Sligo Regional is highlighted in the Performance Report for high levels of absenteeism. It is 13th in the country on a rolling assessment over three months up to August.
Cregg House is placed 112th in a list of 119 named centres, while Roscommon County Hospital is 7th in Irish health settings for absenteeism.
The absenteeism issue in Sligo is once again ‘flagged’ in the summary comment to the Minister.
General support staff (9.75%), nursing staff (7.39%) and and management/admin (6.48%) absenteeism rates in Sligo Regional Hospital all far exceed the national average of 4.7% for the three month rolling period under review.
No reasons are offered in the Performance Report, or elsewhere, as to why absenteeism — and across several grades — remains high in Sligo Regional Hospital.
The Performance Report indicates that nine in every ten incidents of absenteeism is certified — 89.8%
Finally, 1.8 million medical cards had been issued by October 1st — almost 40,000 more than were planned in budgets for 2012, says the Performance Report.
One of the more substantial achievements of this government has been to burnish the reputation of Fianna Fáil which, we had believed, had been consigned to well-deserved oblivion by the outcome of the 2011 election. By Vincent Browne.
As the coalition resolutely persists in its ineptitude, Fianna Fáil doesn’t seem that bad in retrospect.
A disapproval rating of 73% for the Government is fairly decisive. A rating (voting intentions) of 21% for Fianna Fáil is not at all decisive, but it is a significant improvement on the party’s election showing (17%).
But Fianna Fáil will struggle to improve, not because of the calibre of its Dáil representation, or even the memory of the damage it did in government (although that will be hard to live down for a decade or more), but because it doesn’t have enough credible candidates to win seats. The next local elections won’t rectify that.
Fianna Fáil back in office might be, next time round, a little more competent than the present crowd, but essentially no different – as the present crowd are essentially no different to their predecessors.
Much of the damage to the government is self-inflicted, beginning with reckless election promises when Fine Gael feared that Labour might overtake it, and Labour thought there was a prospect of Eamon Gilmore becoming Taoiseach. Fine Gael promised there would be no increases in income tax. Labour promised it would be “Labour’s way”, not “Frankfurt’s way”, and that social welfare payments and the Croke Park deal would be left untouched.
More harm was self-inflicted by wild claims of success, such as Enda Kenny and Gilmore on the supposed deal on the bank debt in June and both of them, along with Michael Noonan and others, about growth returning to the economy.
It remains in the deep doldrums, with falling employment and, alarmingly, rising emigration. More appalling still have been the cuts seemingly targeted at the worst-off, the most egregious of the pending ones being to home help.
And then, of course, there is the James Reilly debacle.
But there has been nothing like the harm that is about to be inflicted with the introduction of the property tax. There will be outrage, some of it justified (such as in the case of those who paid massive stamp duty when buying property immediately before the collapse, and where it affects poorer people).
Most of this outrage is unjustified, because of the culture of low tax that was engendered – by Fianna Fáil in its 14 years in office, and by Fine Gael and Labour during their 14 years in opposition, during which time they berated Fianna Fáil for not indulging this culture even more.
The primary difficulty faced by this government, and by Labour in particular, is the settled conviction of much of the electorate, which Fine Gael would not wish to disturb, but Labour should want to disturb.
That conviction is manifest in part by the “certainties” that we already pay too much tax; that a large part of public expenditure is squandered on extensive social welfare fraud; that significant savings can be achieved through cutting back the number of public representatives, abolishing the Senate and slashing the pay of overpaid public servants; and that an equal society is effectively unworkable.
Nobody in politics challenges these “certainties”. In particular, nobody argues for a radical redistribution of wealth and income, bar the left, which presents redistribution in terms of retribution – which, to most people, is just off-putting.
Part of the reason for this settled conviction is that our political system is driven by greed for office.
The political establishment and the media see the attainment of office as the point of politics, even though holding office does not bring the power to change much, because office-holders are constrained by the prevailing mindset of the electorate. It is through challenging and changing mindsets that power is attained, and that change happens.
It is not that politicians are universally venal, for almost all want to act in what they perceive as the national interest. But there is almost always a happy coincidence between their perception of the national interest and what it takes to gain and retain office. Throughout the boom years, nobody was going to gain office by challenging the driving force of the Celtic tiger, as people’s mindsets had bought into a culture of indulgent self-interest. That mindset is now settled. Without a prolonged counter-assault on the prevailing conviction, little can be achieved or changed.
Those impatient for power have little interest in prolonging anything that will keep them from office. But in gaining office, they find that, fatally, they are constrained by that prevailing conviction and forced to do as before. Just as Fianna Fáil did – and would do now, if they were back in office.
Ms Shortall resigned her junior ministry three days ago following months of conflict with Mr Reilly.
Her resignation came after a row over his decision to add a number of locations, including two in his own constituency, to a list of proposed primary healthcare centres.
Speaking on RTÉ Radio, Ms Shortall described the decision by Mr Reilly to include the two centres as stroke politics.
She also said that she felt let down by her colleagues in the Labour Party and that party leader Eamon Gilmore had backed Mr Reilly and not her.
Ms Shortall also said that Minister Reilly blocked many of the reforms that she had tried to implement.
Ms Shortall said she believes Mr Reilly does not subscribe to the Programme for Government and there were fundamental differences between them on how the health service should develop.
Taoiseach Enda Kenny and Mr Gilmore were present at a meeting between Ms Shortall and Mr Reilly, but it failed to resolve the issues.
Ms Shortall also said that Cathal Magee was “driven out of his job” as HSE Chief Executive.
Minister for Children Frances Fitzgerald has defended Minister Reilly following Ms Shortall’s criticism.
Speaking on RTÉ Radio, Ms Fitzgerald said she believed that there was nobody more committed to reforming the health service than Mr Reilly.
She said that the Government will deliver on its commitments in the area of primary care.
Ms Fitzgerald said reforms were being pursued but could not be delivered overnight.
Fianna Fáil’s Billy Kelleher said Ms Shortall’s comments provided “an insight into the malaise” in the Department of Health.