Can Leo change anything in Health?

golfwallah

He seemed to be making some progress in his last portfolio as Minister for Transport, Tourism and Sport, particularly with regard to tackling the difficult issue of pay cuts in Irish Rail.

But, hard and all as that was, it all looks like a walk in the park compared to his new job as Minister for Health, where he is faced with tackling a budget overspend and a behemoth organisation that is very resistant to change - of any description.

Not an easy job, by any stretch of the imagination - but, as a possible future Taoiseach, Leo has made a very jittery start - firstly by telling us all what we wasn't going to do - as per this Irish Independent article:

The more he tells everyone what he won't be doing as Minister for Health, the more everyone congratulates him. "Finally," we say, "a straight-talking honest politician who doesn't make any false promises."

Now he is being upbraided by Taoiseach Enda Kenny:

"I am far more interested in hearing how you set about achieving what the Government's targets are instead of giving endless, endless volumes of (recommendations) telling me why things can't be done," Mr Kenny said when asked about the minister's interview.

- See more at: http://www.independent.ie/irish-news/politics/zero-tolerance-for-ministers-making-public-budget-pleas-30575317.html#sthash.JSzW7teS.dpuf

It will be interesting to observe developments in the days leading up to the budget - can Leo really do anything meaningful in Health or will we see more playing for time and kicking into touch?

It looks like this is the first real test of Leo's mettle! I do hope he can do it as we could do with a demonstration of leadership in adversity at the moment.

Rightwing

golfwallah wrote: »

He seemed to be making some progress in his last portfolio as Minister for Transport, Tourism and Sport, particularly with regard to tackling the difficult issue of pay cuts in Irish Rail.

But, hard and all as that was, it all looks like a walk in the park compared to his new job as Minister for Health, where he is faced with tackling a budget overspend and a behemoth organisation that is very resistant to change - of any description.

Not an easy job, by any stretch of the imagination - but, as a possible future Taoiseach, Leo has made a very jittery start - firstly by telling us all what we wasn't going to do - as per this Irish Independent article:


Now he is being upbraided by Taoiseach Enda Kenny:
- See more at: http://www.independent.ie/irish-news/politics/zero-tolerance-for-ministers-making-public-budget-pleas-30575317.html#sthash.JSzW7teS.dpuf

It will be interesting to observe developments in the days leading up to the budget - can Leo really do anything meaningful in Health or will we see more playing for time and kicking into touch?

It looks like this is the first real test of Leo's mettle! I do hope he can do it as we could do with a demonstration of leadership in adversity at the moment.

THere's very little he can do as far as I can see. The PS unions are more or less running the country. If you can't sack excess workers, how can the situation be turned around? Same applies for education. Primary school principals sitting on their arses all day, doing 'admin' work :rolleyes:

Grudaire

Rightwing wrote: »

THere's very little he can do as far as I can see. The PS unions are more or less running the country. If you can't sack excess workers, how can the situation be turned around? Same applies for education. Primary school principals sitting on their arses all day, doing 'admin' work :rolleyes:

People who don't think that there is a lot of admin work to be done, probably haven't worked the jobs. (I haven't so you might be right, but your username might imply a slight bias..)

hmmm

Leo has been quite open with the public as to the challenges he faces, including releasing his briefing notes. Kenny seems to want Leo to adopt the old politicians tactic of hiding as much information from the public and talking rubbish about how good everything will be in the future. I know which approach I find patronising, and which approach I appreciate - the time for dinosaurs like Enda Kenny has come and gone.

jank

Leo is taking a long view on things. With an election coming up in the next 18 months he knows he can't turn the whole thing around in that time, so he is managing expectations which is a good thing. O'Reilly had good ideas and if you read Pat Leahy's "Price of power" he does not come out of it too badly, the only problem was that he is not a politician (only a TD in 2007!). He is a GP at heart who wanted to try and make a difference, only the system chewed him up and spat him out.

The whole health thing needs the input of other ministers as well, especially Finance and Public expenditure. The place is over flowing with middle management and admin which should be sacked. Impossible to reform a system where you can't touch 85% of core expenditure. The issue where half the country is on a medical card is farcical but again just untenable to touch it.

Regardless of Leo himself, well I am a fan and would be shocked that he is not the next leader of FG after Enda. Just hope he can escape from health without too much damage.

(Ironic thing is, in Australia I cannot tell you who the minister of health is off the top of my hand but I can name loads of other ministers,.. defence, communication, education, immigration, treasury, AG and so on. That is in itself a lesson where the state and government interferes too much in day to day management of the department rather than providing a long term 10 year plus vision...)

golfwallah

Rightwing wrote: »

THere's very little he can do as far as I can see. The PS unions are more or less running the country. If you can't sack excess workers, how can the situation be turned around? Same applies for education. Primary school principals sitting on their arses all day, doing 'admin' work :rolleyes:

Sure, there's very little he can do, that's easy to do. It also depends on the timescale. But there is plenty that can be done, IMHO, if the will is there and he can bring enough of the various stakeholders along with him.

Short term stuff (between now and next month's budget) will be the most difficult and I guess that is where the spotlight will be focussed for now. I guess it's up to him to demand workable proposals from the senior people in his department - if they can't do the job, then he should replace them with people who can deliver.

Medium term (between now and the next general election), it begins to get a bit easier.

The long term gives more time and is the least difficult.

As for dealing with the unions - no, that won't be easy to deal with either - but I can't accept that it is impossible and nobody said the job was going to be easy.

It's "squeaky bum time" for Leo and were all waiting to see how he performs!

I hope he does the business .... time will tell!

chopper6

Rightwing wrote: »

THere's very little he can do as far as I can see. The PS unions are more or less running the country. If you can't sack excess workers, how can the situation be turned around? Same applies for education. Primary school principals sitting on their arses all day, doing 'admin' work :rolleyes:

What do you work at?

coolshannagh28

Leo will be lucky to get out of health with any reputation ,Enda and Noonan bitchslapping him already, it truly is a poisoned chalice ,interesting to note that the true anointed one dodged this bullet and is bluffing away in agriculture and defence where he can do no harm . Leo will never be leader of FG and may not even be a member in the medium term and would make a good leader of an alternative party.

Sand

All Leo can do in Health is survive. Kenny put him in there to set him up to fail - the carefully leaked criticism is just the first a campaign by Kenny to try and put Leo back in his box. Leo is clever, straight talking (for a politician) and reasonably charismatic and he is not on the "Up Mayo!" wing of the party. Clearly Kenny sees him as a threat.

realitykeeper

Leo Varadkar would have a better chance of changing things if the Taoiseach stopped trying to undercut him. Leo gave his honest thoughts on how he felt the promises that had been made could not be delivered upon. The taoiseach would like him to focus on finding a way to deliver on the promises wheasas Leo would like to focus on what can realistically be achieved. Leo is not a yes man. He is not afraid to break from the party line eg he praised the Garda whistle blowers when the Taoiseach was still defending the Garda commissioners "disgusting" remarks.
Leo`s best chance of changing things would by challenging Enda Kenny for leadership of FG and then running for the post himself. Then he could do his job as health minister without interference or he could appoint someone to that post who thinks like he does.

golfwallah

Sand wrote: »

All Leo can do in Health is survive. Kenny put him in there to set him up to fail - the carefully leaked criticism is just the first a campaign by Kenny to try and put Leo back in his box. Leo is clever, straight talking (for a politician) and reasonably charismatic and he is not on the "Up Mayo!" wing of the party. Clearly Kenny sees him as a threat.

Up to Leo to prove that not only can he survive - but survive and prosper!

According to the "briefing" (brief it is not) document provided to Minister Varadkar by his senior people:

In net vote terms there is a deficit of €208m.
..................
€108m in pay-related savings under the Haddington Road Agreement ..... the review undertaken by PA Consulting concluded that these savings are not achievable

(see page 15 of part 4 of briefing document from Department of Health website: http://health.gov.ie/wp-content/uploads/2014/09/Part-4.pdf)

In the short term, there are real problems when Brendan Howlin can’t deliver on the Health savings agreed under the Haddington Road Agreement. Howlin gets the credit for the agreement and the Minister, whoever that is (Leo in this case), gets it in the neck for not making the savings.

But all that aside, the briefing documents look pretty voluminous to me (almost impenetrable and certainly lacking much in recommendations for savings other than service level reductions).

Maybe Leo should take a leaf from former Taoiseach Albert Reynolds, who always insisted on getting one page summaries or from Churchill who sacked many of his generals before getting Monte to produce his first victory at El Alamein.

gaius c

golfwallah wrote: »

He seemed to be making some progress in his last portfolio as Minister for Transport, Tourism and Sport, particularly with regard to tackling the difficult issue of pay cuts in Irish Rail.

But, hard and all as that was, it all looks like a walk in the park compared to his new job as Minister for Health, where he is faced with tackling a budget overspend and a behemoth organisation that is very resistant to change - of any description.

Not an easy job, by any stretch of the imagination - but, as a possible future Taoiseach, Leo has made a very jittery start - firstly by telling us all what we wasn't going to do - as per this Irish Independent article:


Now he is being upbraided by Taoiseach Enda Kenny:
- See more at: http://www.independent.ie/irish-news/politics/zero-tolerance-for-ministers-making-public-budget-pleas-30575317.html#sthash.JSzW7teS.dpuf

It will be interesting to observe developments in the days leading up to the budget - can Leo really do anything meaningful in Health or will we see more playing for time and kicking into touch?

It looks like this is the first real test of Leo's mettle! I do hope he can do it as we could do with a demonstration of leadership in adversity at the moment.

Maybe I understood Edna's comments wrong but wasn't his comment re "pages of recommendations as to why something can't be done" a swipe at the mandarins in the DoH obstructing reform?
http://www.thejournal.ie/enda-kenny-leo-health-1666020-Sep2014/

golfwallah

gaius c wrote: »

Maybe I understood Edna's comments wrong but wasn't his comment re "pages of recommendations as to why something can't be done" a swipe at the mandarins in the DoH obstructing reform?
http://www.thejournal.ie/enda-kenny-leo-health-1666020-Sep2014/

Enda has hit the nail on the head, IMO, as regards the Sir Humphreys in DOH providing volumes of excuses (so big it had to be broken down into 5 separate sections on DOH website), that end with:

It is becoming clear that unless supplementary funding is provided, service levels would have to be reduced to achieve financial breakeven

Out of a current spending budget of €12.774 billion, these guys are reporting a net deficit of €224m as at end June.

An enormous budget and they can't find ways to come in on budget without reducing service levels.

I hope Leo has the bottle to face them down and demand results - or resignations!

Hotblack Desiato

It sounds bad, but it's less than 2% and much of the expenditure is effectively fixed, or else demand-led.

What's not acceptable though is the standard of service we get given the amount we spend on health.

golfwallah

Hotblack Desiato wrote: »

It sounds bad, but it's less than 2% and much of the expenditure is effectively fixed, or else demand-led.

What's not acceptable though is the standard of service we get given the amount we spend on health.

The current account deficit of €224m is as at end June, whereas the budget of €12.774 billion is for the whole year.

So this would leave the deficit at €448m or just over 3.5% if the current spending rate continues, without management action.

Granted much of the expenditure is fixed or demand lead, but not all of it.

And I agree that the standard of service could be improved. Unfortunately the only solutions being proposed by senior DOH staff seem to be to reduce these service levels even further.

Enda's suggestion to Leo that he get positive proposals for cost reductions (as opposed to reasons for not doing things) may seem simplistic at a superficial level - but they are the only sensible ones around at the moment!

gaius c

Yeah it's basically give us even more money or we'll make the health service even worse than it is.

Head The Wall

They have also spent over their budget for the last few years so it's not a surprise. The fact that they appear to be doing nothing about bringing it in line speaks volumes about their attitude towards their "perceived" budget.

creedp

Head The Wall wrote: »

They have also spent over their budget for the last few years so it's not a surprise. The fact that they appear to be doing nothing about bringing it in line speaks volumes about their attitude towards their "perceived" budget.

Interesting when they did try to reduce spend/deficit by removing medical cards from those who were not legally entitled to them, having been instructed to do so by Govt, Govt stepped in to reverse this decision.

golfwallah

Brendan Howlin is warning ministers not to expect too much from the budget, "to be realistic", according to this Irish Times article.

This is shaping up to be a real test for Leo in his role as Minister for Health.

He is looking for about a billion Euro to balance the books. We've seen the long briefing documents published on DOH website - basically these boil down to reduced services if the health budget is not increased.

Will be interesting to see if Leo can succeed in this tough portfolio, where Dr. Reilly came unstuck - can he realistically deliver more for less in Health - or a credible plan to reform it over time?

Head The Wall

creedp wrote: »

Interesting when they did try to reduce spend/deficit by removing medical cards from those who were not legally entitled to them, having been instructed to do so by Govt, Govt stepped in to reverse this decision.

The HSE seem to think the way to reduce costs is to reduce services and completely ignore staffing costs even after reports stating there are thousands of unnecessary excess staff still employed

creedp

Head The Wall wrote: »

The HSE seem to think the way to reduce costs is to reduce services and completely ignore staffing costs even after reports stating there are thousands of unnecessary excess staff still employed

True all forms of cost reduction should be on the cards but hard to take Govt seriously when they specifically instruct HSE to reduce costs by pursuing a legitimate course of action and when it turns out to be unpopular do a complete u turn! Maybe the Govt should instruct the HSE to only pursue popular cost cutting strategies ..

golfwallah

creedp wrote: »

True all forms of cost reduction should be on the cards but hard to take Govt seriously when they specifically instruct HSE to reduce costs by pursuing a legitimate course of action and when it turns out to be unpopular do a complete u turn! Maybe the Govt should instruct the HSE to only pursue popular cost cutting strategies ..

I guess the words "popular" and "cost cutting" don't fit together easily - never did, never will!

But finding the right combination of funding and better value for money is the real challenge facing our new Health Minister.

Mixing short term budgetary goals with more long-term objectives like cost reduction is no easy matter and requires real political skills.

But if anyone can do this almost impossible task, my money would be on Leo!

golfwallah

The launch of the HSE Service Plan for 2015 represents slow but steady progress in our health service and renews my confidence that Leo Varadkar is leading things in the right direction.
From the plan on the HSE website, its refreshing to see more focus on good governance at top level, with specific mention being made of the Accountability Framework, emphasising more accountability by senior managers:

This enhanced governance and accountability framework makes explicit the responsibilities of all managers to deliver on the targets set out in the Service Plan across the Balanced Score Card in relation to access to services, the quality and safety of those services, finances and workforce. The process involves the introduction of a formal escalation, support and intervention process for underperforming services which will include a range of sanctions for significant or persistent underperformance.

In this regard, any over run from 2015 onwards will fall to be dealt with by the HSE in the subsequent financial year. This places further emphasis on the need for managers of services to operate within their allocated resource limit in 2015. Failure to achieve this will result in having to deal with any overrun as a first charge on their resources the following year.

Leo also seem to have his senior team squarely behind him and has given a few good interviews in the media, without rising to the bait of attributing any fault on his predecessor or party leader. Good progress so far - looking forward to successful implementation of the plan!

Celly Smunt

Leo was set up to fail though he's playing The cards close to his chest as not to show what a mess The health Service is in or The lack of freedom he has to change things within The HSE. If he holds out to elections he'll be moved i reckon.

He is The only one with a head on his shoulders within fine gael from my opinion. He is clearly a threat to Enda due to his popularity within The Party as he shows The most "leader" potential out of The lot. He can't turn down whatever comes his way due to The whip which is rediculous really. If we saw Leo turning down The health role we would see another Lucinda Moment. Kenny at the Moment is an absolute burden/dictator in terms of ministry of The Party. I don't think anybody is willing to put themselves up against kenny as they could lose there Position by rejecting any of his decisions as we've seen before. Leo is a breath of fresh air in The fine gael benches and The sooner he rises is The better for The Party and government overall.

Hotblack Desiato

In this regard, any over run from 2015 onwards will fall to be dealt with by the HSE in the subsequent financial year.

We've heard that every year for the last umpteen. It never happens and it won't happen now. Overspends are always indulged. If pressed they just threaten to shut down emergency services and the government always backs off.

hmmm

Varadkar seems to be steadily dealing with some health service political landmines in a very deft manner so far.

I can see him leading FG and becoming Taoiseach on a wave of support. Unfortunately we have a habit of voting for individuals who we think are omnipotent, and are always disappointed when our leaders turn out to be merely human.