June ’11 Article in IP

A new broom.

Well the general election is all done and dusted bar the Taoiseach’s nominees to the Seanad. The coalition parties have had their late night sessions and divided up the spoils. And it looks like many of the spoils are spoilt. For me most politics are a better sedative than temazepam with the exception of one particular area. Can you guess which one? I’ll give you a clue. If I said Mary Harney with a beard would you know?

When he was first appointed Minister for Health I genuinely wished him well in a blog post that I made. Considering the state of the nation and the state of our health service it is in all our interests that he does well. In one respect I was secretively hoping that I did not have anything to write about in relation to the new Minister. After only a few weeks it became apparent that my creative well for these articles would not dry up. So now after a couple of months on the job I decided to review the new broom.

And to be sure many of the comments that Dr Reilly has come out with make him appear to be a new broom. Saying that he trusted the INO’s trolley figures more than the HSE’s was a biggie. That must have been a kick on the goolies for the civil servants who measure trolley lists and whose sole task in life is to serve the Minister. Ditto when he queried the HSE’s figures for community care practices. I cannot but wonder will these devoted civil servants now be transferred to another task. Or will the HSE continue to churn out their trolley figures despite the fact that now no body pays any attention to them. This healthy mistrust of HSE figures is at odds with his willingness when speaking on pharmacy matters to let the same old guff emanate from the Dept. of Health’s bowels. While not willing to accept his own civil servants figures in relation to trolleys and community practice he is quite ready to toe the HSE line in relation to pharmacists.

One of the first things which struck me about Dr Reilly is his ability to get good publicity. Two actions in particular got my attention. Firstly he announced that he was getting rid of the 50c per item charge on GMS prescriptions. In many interviews after the announcement he outlined all the reasons why the charge should be removed and let me say that I agree with many of these. And indeed he got many good newspaper pieces about this. From a pharmacists point of view there was just a slight niggle with this. He didn’t say precisely when. I imagine that many of you like me have been asked by patients and customers when will medical card prescriptions be free again. The cynic in me says “Don’t hold your breath!”
The next biggie from a PR point of view was when he asked the board of the HSE to resign. “I am going to abolish the HSE’s board and make the HSE more accountable to the Minister.” Lofty ideals no doubt but like the 50c charge when? It appears that there needs to be a change in legislation to carry out this. When will this take place? Well it appears that he still hasn’t even sat down to write the new legislation. He might be doing it for next year. And in the mean time? It seems that he has appointed a number of HSE civil servants to the board. So you have an organisation that is not functioning properly so you appoint to the board the senior people who have been running the malfunctioning body. So as I said above “Don’t hold your breath!”

In some respects the fact that he is medically qualified is a positive for him. Although he has not practised for a number of years his past experience and his contacts should ensure that he is fairly up to date with what is happening on part of the coalface of medicine. However I suspect that many of his actions to improve matters at the part of the coalface that he knows best will be at the expense of other parts of the medical coalface. To put it bluntly he will be a doctor’s Minister for Health. At the community care level I suspect that many of his actions will favour GPs and private community health centres over other parts of the service. One of the ways to reduce pressure on hospitals would be to move much of the management of some chronic conditions to GP level. However in fairness to the GPs I cannot see them taking this on without being paid for it. And where would this extra money come from? The government does not have any spare cash so in all likelihood it will have to come from within the current community health budget. That means yours and my pockets.

An interesting exercise to carry out would be to compare incomes from the GMS for all contracted healthcare professionals. A base line could be done for say 2005, a follow up for 2010 and then 2015. After gazing into the entrails I would predict that by 2015 the GPs will be earning a much higher percentage of the total take. I’ve no doubt that the HSE will be able to claim that rates for specific procedures or tasks have reduced or been frozen. But I foresee that GPs will be earning fees under a whole rake of “new” schemes. I would like to think that pharmacists could do similar. Fees for vaccination programs or M.U.R. are the first two that spring to mind. But alas I just can’t see this in the current entrails. As for me I just hope that I am still around practising pharmacy in 2015. If I am around it just might give me some perverse pleasure to be able to say “I told you so.”

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