Now that single party governments appear to be a thing of the past, it would seem to make political sense for parties that are likely to form governments to explore the extent to which they can agree high level policy approaches, writes Denis Doherty.
Towards the end of a recent television interview, I was asked if I thought a consensus among political parties on health policy would be helpful? I said I thought it would and explained briefly why I thought that. Time didn’t allow further consideration of the question.
History and political behaviour up until now suggest an all-party approach is unlikely to materialise anytime soon. It is equally unlikely that continuing to treat health policy formation in the way we have always done will produce any better results than those that have been achieved so far. Health services are important to everyone and by now we ought to have risen above issues such as discretionary medical cards influencing election outcomes to the extent that this issue is said to have influenced the recent local and European elections.
Soon after the television interview, I attended a performance of the new production of Friel’s play ‘Aristocrats’ at the Abbey and came away thinking ‘that’s a metaphor for the way politicians have dealt with health policy in the past’!
There are those who argue that much of the credit attributed to Browne ought to be given to his Chief Medical Officer, Dr. James Deeney and to the introduction of new drugs
‘Aristocrats’ takes place around the gathering of the O’Donnell family, at Ballybeg Hall in Donegal, for the marriage of the youngest member of the family. That event is overtaken by the death of District Justice O’Donnell, who is seen only briefly, but we are left in no doubt that he is a domineering and controlling figure. The entire family is dysfunctional, but the judge’s disappointment is directed firstly at his only son, who lacks the ability to maintain the judicial line commenced when his grandfather became a judge of the Supreme Court and was followed by his father who was a judge of the Circuit Court, and secondly at his eldest daughter, Judith, the strongest character in the family, who cared for the judge following a severe stroke but who had years earlier betrayed the family, as the judge saw it, by giving birth to a child out of wedlock. Other members of the family experience alcoholism and mental health problems.
It transpires that the decline of the family can be traced back at least as far as the beginning of the judge’s marriage and the fact that the education his children received did not equip them to do anything. They live largely unconnected lives, but their affection for the big house, Ballybeg Hall, provides a family bond of a kind. After the funeral, Judith surprises her siblings by telling them they cannot afford the big house any longer, that it is rapidly decaying and the loss of the judge’s pension means their principal source of income will now cease.
At best, avoiding reputational damage, while holding the health portfolio is considered a success
The imminent dispersal of the family results in important, far-reaching decisions being taken in a hurry and without much consideration for their long-term consequences.
In Irish politics, the spectre of the Big House – Archbishop’s Palace – still influences political decision-making. Some former health ministers are remembered for specific achievements but only Noel Browne is remembered as an outstanding Minister for Health. Even in his case, there are those who argue that much of the credit attributed to Browne ought to be given to his Chief Medical Officer, Dr. James Deeney and to the introduction of new drugs, such has streptomycin, that radically improved the treatment of tuberculosis. At best, avoiding reputational damage, while holding the health portfolio is considered a success.
There have been worthwhile policies developed by parties in opposition that have not subsequently featured in programmes for government. A good example being, in my view, the Labour Party Policy Document on health, published when Liz Mc Manus was their health spokesperson. It surprised me it did not appear to inform the health policy of the present government on health. Now that single party governments appear to be a thing of the past, it would seem to make political sense for parties that are likely to form governments to explore the extent to which they can agree high level policy approaches.
It would suffice that shared, multi party approaches to health policy would deal with strategy, broad policy issues and approaches to funding. This approach can justifiably be short on detail but ought to be strong on commitment.
Healthcare is complex, not exactly nimble and, therefore, not capable of making sudden or even frequent changes of direction. It would be helpful, therefore, if the overall approach to healthcare policy were sufficiently robust so as to facilitate implementation and adjustment over the lifetimes of a number of governments.
How might political, policy and fiscal change of the magnitude that would be involved be achieved? Perhaps the experience of the ‘New Ireland Forum’, of the nineteen eighties, or the more recent ‘Convention on the Constitution’ might provide guidance on how best to approach the task.
The New Ireland Forum helped develop a nationalist consensus that informed the subsequent Anglo-Irish Agreement, which in time contributed to the Good Friday Agreement. The approach suggested may not result in the political careers of Ministers for Health being enhanced, but it might well bond the political equivalent of the O’Donnell family in a way that has not happened up until now while allowing them to maintain their attachment to their big house – Leinster House.