Ireland, and the case of the discretionary medical card.

Historically if you suffered from a serious medical condition you could have been issued with a medical card, allowing you to receive free or reduced cost healthcare services from the state. The mechanism for issuing of such cards seemed to be arbitrary from region to region, and in a financially compromised country where recently the government has been marching to the drum of austerity, anything left to discretion has already more or less disappeared over the last couple of years. All things considered it was really only a matter of time before this happened but unfortunately there hasn’t been any joined up thinking (Something the current and past governments have all suffered from) which would have allowed medical cards to have been issued to people who need them, apart from an antiquated method of means testing. If you considered the issuing of discretionary medical cards as arbitrary I would probably call the means testing method more of a lottery. Yes, you have to be in it to win it, but the numbers are against you.

During the last couple of weeks an increasing number of stories have hit the news where seriously ill people have seen their discretionary cards removed. Improving efficiency, cost cutting, call it what you will, this has pulled the rug out from a lot of hard pushed families. Since taking over his position, James Reilly, minister for health has repeatedly reported budget shortfalls and spending overruns. Like “Oliver” he keeps coming back to the table asking “Can I please have some more”. He seems to be unable to create any form of efficiency in administration, while cuts are continually applied to frontline services only, and yet the budget failures continue. What exactly is happening?

I’ve spoken with a few people recently and the general feeling is that they are attempting efficiency through bureaucracy. First they remove all medical cards and then require all candidates to reapply. The process of jumping through various hoops can be difficult for some. I would assume older people, or people from a less educated background would struggle facing form after form to complete before starting an assessment process which did not remotely guarantee the card would be issued. This creates a form of natural efficiency. Some people will decide the process is just too difficult, some will try to struggle on without and make ends meet. Some of course will die and most of all thats a form of efficiency that brings a confirmed and final tally to James Reillys ledger.

Recently the independent TD Clare Daly questioned the government on the outsourcing of the medical card system to a German company “Arvato”, pointing out that the company employed a staff of almost entirely contract staff. She questioned if any had specialist training in the healthcare sector, or if they were purely bean counters from the financial sector (I paraphrase of course), who would be employed to act like the sword of Damocles and cut mercilessly. I think there was a little bit of point scoring on her part by pointing out it was a German company, with the growing use of the term “Berlins way, or no way” being used to signify an anti Europe or Anti Austerity message. While Clare’s heart is in the right place I wonder if she could have asked better or more probing questions.

If a process is being outsourced, what are the efficiencies being made to the existing system of administration. What are the costs and what are the overall savings. Could we get an overview of where outsourcing currently takes place across the public service and a comparison of current expenditure and past expenditure based on the proposal that outsourcing has brought efficiency and cost reduction. What was the tender process and are we continually researching alternative methods of efficiency in these services.

So who is Arvato?

Arvato is part of the Bertelsmann Group. A German super conglomerate. You’ve probably never heard of them, or at least assume you havent. If you’ve purchased any chart music in the last few years you probably paid directly into their coffers. Look at the back of your CD collection. If you see Sony BMG on the label the BMG stands for Bertelsman music group. Bertlesman is one of the world’s largest publishers and apart from Music, if you’ve bought a book from “Random House” again you have paid directly into their pocket. Arvato sits within the group as a process outsourcing specialist. Large companies around the world outsource their financial processes to Arvato, or Arvato provide contract staff to work on site. Their main Irish headquarters are based in East point business park and regardless of Clare Dalys subtle possibly unintentional xenophobia I’m sure Arvato have a strong Irish staff at the core of their Dublin organisation. But moving back on point, do we know how much efficiency or cost saving has this company brought to the HSE? Sick children without medical cards shouldn’t be seen as loss making or inefficient to the public purse. The most recent public report from Bertelsman dates from 2012 where gross profit stood at around 16 Billion. What will their figures for 2013/2014 read?

I’ve used the term death by 1000 cuts recently and I think it accurately reflects what is happening in the health service under the Fine Gael / Labour government. Despite the public mantra that cuts would not affect front line srrvices, the continued reality for those seeking access to care is that the services themselves are being wound down or relocated. Maternity services is one of the most high profile. From Portlaoise to Cavan to Sligo we are hearing that staff reductions and closures are now the norm. While some would say its hyperbole to link the recent rise in child mortality to the cuts in spending we must see some correlation. Its not like we’re linking it to changes in rainfall. I believe that this is a circular process. Reduced cover leads to a rise in safety issues and concern for public safety is justification for closure of local services. Conversly the truth would be that investment at local level would have prevented the rise in safety issues. But the key point is wise investment. I’m not oblivious to the fact that we still believe that the country is broke and act accordingly. Specifically using the HSE as a test case, how much outsourcing is now happening and are the current budget overruns a symptom of things yet to come across other sectors

Its my personal opinion that James Reilly should receive the same treatment as Alan Shatter and be run out of office, but who else wants the poison chalice of the HSE. Who else would we trust to implement root and branch reform? If a Doctor is incapable of healing the sick HSE then who else can we hope to see it through. We derided Mary Harney, and now we despise Reilly as well. Unfortunately their are no answers here. If you read this far hoping that I would produce some panacea, like the government I’m afraid I will have to let you down. I do believe that this proud country can solve its own problems but I think we need stronger voices who speak for the people with long term goals. Parish pump politics that serve the few at the top needs to end.

Stay well out there people

Sources:

The medical card scandal

Bertelsmann Group

Bertlesmann Financial Report 2012