Micheál Martin's handling of the SARS crisis may damage his health reformplans and his hopes for the Fianna Fáil leadership, writes ArthurBeesley.
Is Micheál Martin clinging by his fingernails to keep command of the State's vast health network? Perhaps not - his grip is firmer than that. Yet the golden boy in Fianna Fáil has been damaged by the system's confused response to the threat from SARS, the deadly flu-like condition that has brought fear, illness and death to many parts of Asia and Canada.
Just one case of Severe Acute Respiratory Syndrome has been diagnosed in Ireland. But, despite Martin's best efforts to contain what remains only a potential threat, albeit from a dangerous and unidentified virus, he has endured heavy political flak over his management of the affair.
A new sense of crisis burst into the open over Easter when it emerged that a Chinese woman displaying apparent symptoms of the contagious condition was not quarantined, but told to return to the hostel in Dún Laoghaire where she was staying. Only after a search in central Dublin was the woman admitted to hospital. When there were medical tests, Martin's department and the Eastern Regional Health Authority gave contradictory accounts of her condition.
In an arena where confidence in the response of the system should be crucial, it was a stark illustration of administrative disorder. What is more, public health doctors were on strike over pay and working arrangements. Thus was Martin thrust into the thick of a situation in which the very specialists responsible for treating possible SARS cases were involved in a tense industrial dispute.
While the SARS problem escalated internationally, the Minister was the public face of the crisis at home. As doubt emerged over compliance with World Health Organisation guidelines, it was a lonely place for Martin to be. A letter-writer to this newspaper, citing experience of checks at Dublin Airport for possible contact with foot-and-mouth disease, and no mention of SARS, seemed to sum up a sense that the Minister was not in total control.
A Cabinet source said this week that there was no truth in suggestions that Martin had lost the confidence of fellow ministers through his stewardship of the problem. This assertion was supported by several other reliable political sources, including, not surprisingly, those close to Martin.
But for the Health Minister, these events take place against the backdrop of a much broader canvas. A number of crucial issues are at play, not least his own political ambitions. Seen as a contender to succeed Bertie Ahern as leader of Fianna Fáil, he was Minister for Education before going to Health in 2000. There he succeeded another leadership contender, Brian Cowen, whose distaste for the brief and its near-constant problems was summed up in his description of it as "Angola".
Cowen is perceived to be close to Ahern, who appointed him Minister for Foreign Affairs in 2000 and made him deputy leader of Fianna Fáil last year.
The Machiavellian interpretation of Martin's appointment to Health was that it was designed to soften his cough. For example, Cowen was engaged this week in the grandmaster diplomacy of the peace process, far from the issues of SARS and the doctors' strike that were preoccupying Martin.
Even if SARS does not emerge as a significant health problem in Ireland, Martin is preparing in the immediate term for what will be his greatest political challenge yet: reforming the entire health sector. Crucial decisions will be made at a meeting on Wednesday of the Cabinet subcommittee on health, which includes Ahern, Tánaiste Mary Harney and the Minister for Finance, Charlie McCreevy.
Martin will embark on the reform process in context of budgetary constraints that are already leading to cutbacks in the health service. In addition, he and McCreevy have engaged in a rather public debate about health funding. Martin has argued that the Government is in danger of undermining its achievement in health, citing an increase in the number of procedures and treatments available to patients. But McCreevy wants better value for money. Pointing to a steep increase in health expenditure to about €9 billion this year from €5.6 billion in 2000, when Martin took over, McCreevy says he cannot continue to increase funding for a system that is still not delivering.
With about 70 per cent of the budget going on pay to staff, the number employed in the sector has risen to 96,000 this year from 81,513 in 2000. One senior civil servant, not linked to the health system, says: "We're pouring money in an uncoordinated way into an administration. There's one funnel going in and we don't know where the money is going."
In advance of the meeting next Wednesday, it appears that McCreevy seems to have won the debate already. According to several reliable political sources on the Fianna Fáil and PD sides of the Government, the focus will be on value for money. McCreevy is perceived to have set the agenda early on by appointing a Commission last year, chaired by Prof Niamh Brennan of UCD, to look at financing of the sector. With Martin making it publicly known that he wanted more money for health, there are suggestions that he and his officials were not altogether pleased with this development.
The Brennan report will be considered next Wednesday, along with two other consultancy studies commissioned by Martin, on health system structures and manpower. With 54 separate agencies in the sector, it has been well signalled in advance that the number of health boards, for example, will be reduced radically. In an area where effective administration is often hampered by the existence of an independent republic mentality in certain agencies, the reform battle will pit Martin against highly-paid medical professionals and a powerful, widely-extended managerial class. Neither group will lightly accept change.
Well-placed political sources say attempts to reform the system would have the full support of the Government. But similar sources, at various levels in the political system, say Martin's authority in the reform initiative could be diminished by the fact that he spent much political capital in the very recent past trying to increase health funding.
In addition to the change of purpose, they say there is also a perception that Martin spent too much time fighting fires instead of taking an over-arching role in guiding the broad direction of the system.
Others say the events over Easter exposed such weakness in the system that the case for reform is indisputable. The question asked by some political insiders is whether the Minister still has the authority for the job. This is the immediate task facing Martin, who is also likely to face pressure from lower-level political colleagues who will lose places on health boards if they are abolished.
The test may be some years away in terms of Martin's own leadership ambitions, but it will be marked by his performance now. Even though many observers believe that Ahern is determined not to stand down soon, the stakes are already high. No Fianna Fáil leader yet has failed to become Taoiseach and Martin knows that demonstrable political success is a sine qua non for anyone with leadership aspirations. From this flows the sense of authority that is the crucial ticket for entrance into the political super-league.
If no health minister can expect to retain an untarnished gloss while in the post, there is always a danger that the undercoat may begin to peel too. As the war in Iraq intensified before Easter, SARS was already emerging as a serious international health threat.
Yet when a problem arose at home some weeks later, the system malfunctioned badly. While it always takes time for the State to respond to crises of this nature, the immediate crisis could have been a great deal worse than it turned out to be.
Micheál Martin was Minister for Education in a time ofplenty, when money flowed into schools for the first time in years. Before the hardy days of the long-running pay campaign by secondary school teachers, it was something of golden age. Observers say there was a sense that he was never really challenged in the education post.
How things change.