Just Mary (16 page)

When talking of Private Secretaries, I am anxious not to overlook the great importance of civil servants in general and the huge — and often unsung — contribution which is made by
those who work within Departments. I never forgot that in his earlier days, my father had been a civil servant and he would often speak of what can be achieved where there is a good working
relationship between the civil service and a Minister. Each party has a powerful dynamic which, if used correctly and in tandem, can lead to great momentum within a Department and very fruitful
outcomes. As a Minister myself, I was always mindful of that and tried to manage this dynamic to its fullest ability, and in turn, the civil servants I worked with responded with me and to me.

To my mind, however, there has always been a lacuna in that relationship and that lies in the question: who is ultimately responsible? The files on a particular issue come up to a Minister and
then the Minister has discussions with various civil servants — and I always believed in having these discussions down as well as up the lines of authority. Then a final summation is
presented to the Minister for approval or disapproval. I would always read these files with great enthusiasm, working through the wordy sentences in order to grasp what they really meant in
practical terms. Finally my decision would have to be taken. In that sense, the decision is taken on the advice of the civil servant.

So who then is really responsible? Of course, in the final analysis, one will say, it is the Minister — it is he or she who is in charge. But there has been a huge reluctance in Ireland
for any degree of blame to ever be attributed to a civil servant, either to a top civil servant or someone further down the line. Yet how many incorrect and uninformed summations will have been put
forward to a Minister for approval? I was always very much aware of this danger: that is why on so many occasions, I added questions to a final document, asking for the whys and the wherefores of
how a particular conclusion or recommendation had been arrived at. It does seem lopsided in some ways to me that the Minister is always held responsible, regardless of what decisions have been put
to him or her, and their accuracy. It is an unsatisfactory state of affairs, I feel, and legally and legislatively, there does not seem ever to be a proper way of resolving the issue. But there
should, I believe, be greater accountability within the ranks of the civil service.

Anyway, back to November 1991. After my conversation with Charlie Haughey about my new position in Cabinet, I duly went back to David Gordon in the Department of Education with the news.
‘Heigh-ho, David,’ I said, ‘we are going to the Department of Health!’ We soon learned that we would meet there the new Secretary General, John Hurley (who was later to
become Governor of the Central Bank). John would be pivotal to much that unfolded in my new post.

Although Charlie Haughey had for the present won the day and succeeded in quashing his detractors, things were far from harmonious, and once the new Cabinet was in place, we settled back to work
in an uneasy run-up to Christmas 1991. Albert Reynolds was now very much the focus for those in the Fianna Fáil parliamentary party who wished to topple Charlie, particularly those led by
what I referred to as the ‘Gang of Four’ — Noel Dempsey, Liam Fitzgerald, Seán Power and M.J. Nolan. Other key figures were Noel Treacy, Máire Geoghegan-Quinn and
Pádraig Flynn. At the same time Albert Reynolds was much preoccupied with his own domestic troubles, as his wife Kathleen had been diagnosed with breast cancer. Christmas came and went, and
Charlie was still at the helm — but many of us had the sense that the current situation was a precarious one.

Regardless of all this, I was determined to make the most of the challenges of my new posting in Health. To that end, every night I would trawl through the huge files — related to various
aspects of health — which had come up to me for signature. Some of these dealt with very specialised issues, but which I was determined to master in a factual, knowledgeable way. I had got
into the habit in the Department of Education of reading as many of the back files as possible, and I continued to do so now. But in an area I knew so little about, I had to work much harder than
previously. Nevertheless, I would bring the biggest dossiers home with me at night and read as if I was preparing to give a lecture or go to a lecture. I was thankful once more for my ability to
absorb new information like a sponge.

As it transpired, I would only be in Health for three short months, but some significant episodes from that brief period have stayed in my mind. The first of these was that, within a few days of
my having been appointed, I was contacted by Gemma Hussey, who had been my predecessor as Minister for Education. Gemma had since left politics and was now Chairperson of the Dublin Rape Crisis
Centre, and she was seeking, with a small delegation from this organisation, to meet with me. I readily agreed. The purpose of their visit to my Dáil office was simple — they were
looking for more finance for the running of their Dublin operation. Fortunately, we were able to accommodate this. It is a very good cause, and the women who started the centre were brave in the
extreme, to take on what was at that time a taboo subject, even for discussion purposes, let alone in terms of funding. The Eastern Health Board, under whose auspices the Leeson Street Dublin Rape
Crisis Centre fell, had been sparse in their funding and indeed had not been very open-hearted about the matter in general. But we changed that, I am glad to say, and set an example which has been
followed by subsequent Ministers, luckily. Ever since then, I have kept up great contact with the Dublin Rape Crisis Centre. In the interim, Gemma Hussey has moved on and they have had a succession
of Chairpersons there, with all of whom I have been able to maintain very good relationships.

Another very interesting development during my short tenure in Health was in relation to the distressing phenomenon of cot death — such a sad thing for any family. A mother and father will
go to sleep with their lovely bonny baby in the cot beside them and wake up in the morning to find the baby still and lifeless, or a baby will be put down for a nap during the day, only to be found
lifeless in the cot when the time comes to wake the child. Numerous studies had shown that there was no predisposition in these infants to such an event, which could happen any time from the age of
two months to twelve months: there appeared to be no underlying medical cause as to why. Numerous theories were being advanced at the time as to the whys and wherefores, and research efforts were
beginning to focus on the physical position in which the child was laid down for its sleep.

At that time I had been following with interest the endeavours of Anne Diamond, the
ITV
presenter, who had tragically lost a child to cot death and who had taken up the
cause. Anne came to Dublin and met with me and we had a very good exchange. It seemed clear to me that, in the end, all of the studies pointed to the fact that when putting a baby in its cot, it
was better to lie the child on his or her back. It doesn’t sound like much now, but this realisation then was momentous and hugely significant. Soon we got to work on a circular, which was
sent out by the Department of Health to all the health boards and hospitals, maternity homes, nurseries, mothers, and to public health nurses in particular. The main message was that the Minister
and the Department were of the belief that, when being put down to sleep, a child was best positioned on his or her back. The following year there was in fact a reduction in cot deaths and this
continued to be the case in the years which followed.

Now, why did I make up my mind so readily on this? Well, apart from looking at all the many studies, I also thought back to my time of rearing my own two sons. I had never laid them on their
tummies. This practice, of putting a child face-down in his or her cot, had been a newfangled idea which swept Europe and the world at the time. It was thought to be best then, but it was,
tragically, proved not to be so. I know that the anguish continues and that there still are cot deaths. I often think of bonny children who would have grown up to be fine adults.

In my time in Health I also undertook to play a prominent role regarding the
AIDS
issue, in which I had a huge interest. As we know, in the mid- to late 1980s,
there was a massive
AIDS
scare on an international scale, and a belief that it could become a worldwide epidemic, mowing down all in its path. At that time we truly thought
that
AIDS
was going to overwhelm the world.

Rory O’Hanlon, my predecessor in Health, had started the government’s
AIDS
campaign, and I took it up in a very upfront, in-your-face way. We put out the big
ads, hosted seminars and talks, and so on. While everyone was very worried about
AIDS
, there was also a really unhelpful attitude prevailing at the time — a
‘don’t-talk-about-it-because-it-has-to-do-with-sex’ approach. Working in close conjunction with the new Minister for Education, I aimed in my own way to play a role in the
demystification of the disease, trying to dispel the attitude of horror people had, and the hysterical feeling that it was going to sweep the world. I went out and met people with
HIV
/
AIDS
; I also did my best to encourage and foster the various support organisations which were being set up. I remember in particular making a valuable
contact with a very good guy in Dublin — Ger Philpott, who wrote a book about his partner who had died from
AIDS
. Ger ran a Trust that had been set up to combat and
raise awareness about the illness, and he and I became very friendly. In all the work that I’ve done, I’ve always had a habit of cultivating and working with people I like, and I have
always followed my instincts with such people, even if they might be regarded by others as a bit ‘out there’. I was definitely a bit like that in Education too, and also later in Public
Enterprise, particularly in relation to the trade unions, in which I was always a believer.

It seemed to me that in that period of the early 1990s, we were living through terrific technological advancements in all aspects of life, and particularly so in the realm of health. Wonderful
new drugs were being developed, which promised to prolong life or stave off debilitating diseases. Consequently, the world’s population was getting older, propped up mostly by these
technological advances in medicine.

All of this led to a review of health spending. I noticed then — and it continues to be the case — that in the
UK
, under their National Health Service, such
wondrous life-enhancing drugs were rationed. In other words, not every wonderful new drug which might have afforded an extra lease of life to patients was to be dispensed and paid for by the
NHS
. There were and are no such limitations here — as yet, anyway. If a drug had passed all the national drug tests and was proved to be safe to administer, well then,
it was widely made available, either completely free of charge to those on medical cards or, for those on the long-term medical scheme, for a monthly payment which represented a very small fraction
of what the over-the-counter costs would have been. I know that we constantly moan about the health system in Ireland, and yet, as I say, just look at the
UK
’s
NHS
as regards newly-developed drugs. It is wonderful what research, development and technology has done in the area of life-affirming medicines and I have always felt it is
important to pay full tribute to all those involved in that often thankless task.

Equally, while the capital cost of medical practice in Ireland was and is huge, even back in the early 1990s, we in Ireland were able to continue to sustain a variety of hospitals throughout the
country — from small cottage hospitals in remote western areas, to wonderful, state-of-the-art places like St James’s, Beaumont, the Mater and St Vincent’s. It was clearly not
possible to do all that ad infinitum, and yet any nod towards rationalisation in the hospital facilities on offer led to endless marches, protests and deputations. This was understandable: a
hospital means so much to a town. It is a safeguard to the people, a reassuring place to which they can get their loved ones quickly and easily in times of illness and emergency. When cutbacks had
to be made, and it was my job as Minister to set them in motion, the rational part of my brain always recognised quite clearly that the right course was being taken. Needless to say, I could fully
identify too with the very strong feelings behind the public’s protestations.

I continued to try to learn all I could about health while I was in the Department, even though I had, as others did, the sense that our days were numbered. Many macro health ideas have stayed
with me since then and I have a huge and an abiding interest in the big, general issues of health, and its related spending and consumption in the world. I served happily and I hope fruitfully in
my short time as Minister in that field.

Over the period of Christmas 1991, rumblings of discontent against Charlie Haughey continued unabated. By this stage Albert Reynolds and Pádraig Flynn — along with Máire
Geoghegan-Quinn and Noel Treacy, who had also recently left Cabinet or junior Cabinet positions — were openly speaking against the Taoiseach. Christmas came and went, and when we arrived back
in early January, it seemed as if Charlie Haughey might yet be unassailable — but of course this was not to be the case. Leinster House at this time was a hotbed of gossip. Far worse than
women hanging over half-doors blethering, men were in corners plotting, their embittered faces and tongues willing on the demise of their wounded leader. Something was going to happen soon.

Quite early on in the New Year, in mid- to late January, I heard that Dr John O’Connell, who had at one time been Ceann Comhairle, had his sights set on the Department of Health and the
Minister’s job. This I could understand, I suppose. O’Connell had aligned himself quite firmly with Albert Reynolds and was viewing him as the putative Taoiseach. It was a weird
feeling, however, to know that, whilst you were serving and acting as Minister for Health, there was in fact an aspirant for your post waiting in the wings, preparing to jump into Hawkins House and
take over your work.