Previously published in the The Times Ireland Edition.
There must be, in the Department of Health, a particular well-thumbed file. Let’s call it The Groundhog Day File, given that it must be reached for, with a heavy sigh, by some senior health official every time a new health minister approaches his or her first winter.
“We must do something!” the panicking politician will cry.
“Well, we could increase the number of beds, hire and train three extra nurses for each bed to provide 24 hour coverage, hire extra support staff, hire extra doctors and build new buildings to store them all in,” the official will say, reading off the first page of the file as if they have to.
“How long will that take?”
“Oh, between five and twelve years?”
“What? Joe Duffy will string me up. I need an answer now!”
“We could probably scrape about 60 beds together? With some overtime, rejig rosters, blutack…”
The minister then slumps in his seat.
“How are we not prepared for this? This happens every bloody year! Why weren’t these plans put in place five to twelve years ago?” he asks.
The official will smile a smile that simply says “Ah, bless.”
“Because, minister, five to twelve years ago when we said this to the minister, he said he needed an answer right then. But if you were to start spending today’s money on future planning, you could avoid a minister twelve years from now having this problem.”
The minister explodes.
“What? Make decisions now so that that some fella twelve years from now gets all the credit? Screw him! Where’s that blutack?”
And that’s pretty much been the situation for as long as Simon Harris, minister for health has been actually alive. We’ve had Michael Martin, Michael Noonan, Mary Harney, Brendan Howlin, James Reilly and Leo Varadkar as minister, and the one thing that has united all has been the issue of A&E and beds, during good times and bad.
Every year we have the same story, the same individual stories of pensioners on trollies for x hours. The great Gordian Knot of Irish healthcare. The same questions by the public: why is it still a problem? And the same solution proposed by whichever party is in opposition: more resources.
Here’s the reality. Repeat it after me: There are no votes in fixing waiting lists. There are votes to be lost by fixing them.
Yes, I know, it sounds counter-intuitive. Surely the Irish people would shower with votes the minister who finally fixed a problem that had seized the popular imagination. That was debated and discussed and cursed in pubs up and down the country? That touched pretty much every family?
Nope. For some reason, modern Irish voters do not reward their politicians for solving national problems. Remember when driving tests were a saga? When you went months and months before you could get a driving test? Older readers will remember that. Then the late Seamus Brennan fixed it, and bugger all good it did for him. Mary Harney pretty much singlehandedly wiped out Dublin’s smog problem. Dublin had a smog problem? There you go. The late Jim Mitchell saved the taxpayer millions through the DIRT inquiry. Lost his seat in the following election.
The Irish electorate don’t do gratitude. So there are no votes in fixing the big problems. But there are votes to be lost. Investing now to ensure that a decade from now we have more bed capacity will cost money now, with little benefit today. But it will also mean taking money away from other spending commitments, and that becomes the story.
“More cuts from minister”. Not “Minister redirects limited resources for better long-term gain”.
There are no votes in long-term policies. That’s not unique to Ireland, it’s actually a cancer at the heart of modern western democracy, that voters want everything now. Almost every major social problem requires planning and spending of today’s taxes to avoid problems in the future. But you cannot get votes on that platform.
I’ve mentioned in this column before that my background is in the construction industry. As a result, I’ve had an opportunity to visit sawmills and forests in Sweden. What’s interesting is that many of the forests are relatively close to the sawmills because as the original forests were cut down, the sawmills replanted them knowing that they personally may never see the benefit. In fairness, Coillte does the same here. But as a general concept in Ireland, it’s a rare beast.
There’s some part of the Irish psyche that can’t comprehend long-term, and it is hurting us. As to the solution, consider this: maybe it is time to take things like housing and healthcare out of politics altogether. Supposing if the Dail decided to appoint a non-political health minister for a fixed ten year term, to implement an agreed long-term plan and budget. The problem with that is that it would strip the opposition of the issue and all the heat and emotion that goes with it. A minister who actually took on those whose salaries and pensions were paid from the heath budget, or “vested interests”, to give them their popular title, would become very unpopular very quickly too.
Politicians wouldn’t like it because their employers, the voters, wouldn’t like it. Nobody likes going to the dentist even though we know we have to.
That’s the thing about democracy: tomorrow is nearly always someone else’s problem.