Minister for Health James Reilly’s addition of two towns in his own constituency – Balbriggan and Swords – to a list of primary care centres is still causing controversy, two weeks after this story broke. Despite rounds of questioning in the Dáil and long media outings by Minister Reilly, we are no clearer now on how they got on the list and what criteria were used to compile the list. By Sara Burke.
There is a government commitment to develop primary care centres (PCCs). There are three ways of funding those centres –
- The State pays and builds the centres itself
- Through Public Private Partnerships (PPPs)
- Through leasing
The previous government’s preference was leasing sites. Some are already being built and paid for in full by the State, especially in areas of urban and rural deprivation. In July 2012, as part of the Government’s stimulus package, a list of 35 locations – out of which 20 PCCs were to be developed through PPPs - was published by James Reilly.A story two weeks ago (21 September 2012) by Paul Cullen in the Irish Times revealed that James Reilly had added five locations to the list of 30 drawn up by the Department of Health and the HSE, under Róisín Shortall’s tenure as Minister of State for Health with responsibility for Primary Care.
When questioned about the controversy the day that the Irish Times’s story broke, on RTÉ’s News at One, James Reilly explained that he thought there needed to be more sites on the list than the initial number, along with other criteria taken into consideration in choosing them. He also announced proudly that Balbriggan and Swords were progressing through leasing arrangements.
So why were Balbriggan and Swords on the Public Private Partnerships list when they were already progressing through leasing arrangements?
Reilly is still trying to explain this. On Today with Pat Kenny and in the Dáil on 3 October, James Reilly spoke at length about there being a ‘fluidity’ between the lists, a situation that is in ‘flux’.
Balbriggan and Swords appeared on the PPP list even though the minister knew they were already being progressed through leasing because he wanted to make doubly sure they got built, or he wanted the credit for getting two new primary care centres in his constituency on the list.
No matter what the explanation, it has landed him in a terrible mess, a mess he created himself. Róisín Shortall described the move to add Balbriggan and Swords to the list as ‘stroke politics’, the final nail in the coffin that caused her resignation. And while there is no reason to believe that Reilly benefits in any way financially from getting them on the list, he definitely gains politically if and when, in the run to the next election, there are two shiny new primary care centres in his constituency.
And critically we are no clearer now on what criteria were used to add the five new locations to the list, despite many outings and various ministers fielding questions on this. We have heard different explanations and criteria from different ministers and even different criteria from Minister Reilly.
There is substantial documentation on how Róisín Shortall got her list - which was based on deprivation combined with services and accommodation - released under FOI. There is no such detail for the updated Reilly list, and I presume that’s because no such list exists, and the criteria were being made up as the controversy rumbled on.
“The criteria are quite extensive and because all of them act in different ways it is a bit like a multiplier. One and one makes two and two and two makes four but four by four makes 16 and not four and four which makes eight, and so it is with this. It is a logistical logarithmic progression. There is nothing simple about it.”
Nothing simple at all, minister. Any rationale that takes so much explanation and makes so little sense is surely confirmation that no such criteria exist, which is why the minister cannot produce them nor explain them.
The ‘fluid’ list or ‘state of flux’ is exactly how not to make health policy, because what it allows for is political interference and the very type of politics that this government said it would end. The Programme for Government promises to release us from the old politics that created the crisis, to “open up the budget process to full glare of public scrutiny in a way that restores confidence”.
In one of the communications released under FOI to Sarah McInerney of the Sunday Times, Shortall makes the point to Liam Woods, HSE Finance Director, she wanted primary care centres’ locations decided like national schools so that there are clear criteria that communities and people understand. No such public scrutiny or public confidence in how primary care centres were selected is yet apparent.
And this is important, as it’s not just 20 or 35 centres - the HSE report says we need 297 more PCCs, so these unknown criteria can influence how and where these centres are located. No clarity or transparency yet… Quite simply, Reilly’s hand picking of two towns in his constituency is a classic example of pure clientalism, of old style Irish politics. Nothing new in that.