David Cullinane TD wants to be health minister in the next government. Following his six-month national tour of the island’s hospitals, the Sinn Féin frontbencher sits down with Ciarán Galway to outline his alternative vision for healthcare.
In 2016, after failing to secure a seat in three successive elections in Waterford, David Cullinane became the constituency’s first Sinn Féin TD in over 90 years. In 2020, he topped the poll with a record-breaking number of first preference votes.
Attributing the development of his “left-leaning” republicanism to conversations with his grandparents on his mother’s side, who were “staunchly Fianna Fáil and staunchly republican”, alongside his experiences growing up in a working-class estate in Waterford, he felt Sinn Féin was the “perfect fit” for his own politics. To Cullinane, Irish republicanism “is not just about a united Ireland; it is also about a socially just Ireland”.
When he joined Sinn Féin, it was a small political party with no elected representatives in Waterford. Though, initially, he had not considered standing for election, the opportunity presented itself in 2002, a general election which he describes as “a baptism of fire”.
For Cullinane, it marked the beginning of a protracted march upon the Dáil. “Election after election, standing to build and increase the vote, knowing in your heart that in most of these elections it was always going to be difficult to actually win a Dáil seat, but you have to put in the hard graft and keep building,” he recounts.
Ultimately, the perseverance of the Sinn Féin grassroots in Waterford paid off. This was exemplified in the 2019 local elections when it was of the few constituencies in which party held onto all its council seats in what was an otherwise disastrous election. Breakthrough came in February 2020, when it secured nearly 39 per cent of the first preference vote.
“That shows the phenomenal growth that Waterford made. We can now see that outside of Donegal, Cavan-Monaghan, Louth, and one or two other constituencies in Dublin, Waterford is a really strong constituency for Sinn Féin,” Cullinane says, adding: “That is down to persistence, hard work, party building, building credible politics, and building both Sinn Féin and my own credibility on key issues in Waterford as well. It certainly was a long and sometimes difficult journey, but when you see the results of the last election, one that was worth it.”
As expected, following the 2020 general election, Sinn Féin president Mary Lou McDonald TD undertook a rotation of her parliamentary party frontbench. In a surprise move, however, Cullinane replaced Louise O’Reilly TD as spokesperson on health.
Crediting O’Reilly for her developing Sinn Féin’s policy platform in the health remit, he remarks: “I always had an interest in health, and locally, health was always the issue that I understood best. I had a grá for it. When I listened to other political parties, over a long number of years, talk about health as a ‘poisoned chalice’ or as the ministry that you do not want, that it was the one that I did want. If you make positive changes in healthcare, it has such a huge impact on people’s lives.”
Praising Sinn Féin’s other health-oriented spokespersons, including Pauline Tully TD, Patricia Ryan TD, Mark Ward TD, and Tommy Gould TD as having “done some of the heavy lifting” in the areas of carers and disabilities, mental health, older people, and addiction and recovery, Cullinane indicates that his primary focus is on acute, primary, and community care.
“I have put in the hard yards and hopefully, over the next while, as we get closer to a general election, I can demonstrate that I have the knowledge and we have the policy platform to convince people that we can make serious changes in healthcare,” he asserts.
In seeking to develop understanding of his new remit, the Waterford TD embarked upon a national tour of Ireland’s hospitals, north and south. Over six months, he travelled to 14 hospitals in 10 different constituencies, meeting with 106 interest groups, ranging from hospital managers and CEOs, to consultants, nurses, healthcare assistants, GPs, dentists, patient groups, and trade unions.
“That was really powerful because it gave me a first-hand insight into what the issues were. I moved from an academic understanding of what the problems are to an on-the-ground and realistic understanding,” he recalls.
Admitting that the onset of the Covid crisis steepened his own personal learning curve, he makes specific criticisms of the Government’s overall response. While acknowledging “things which were done right” and suggesting that “I think that the political system was united in the overall public health response”, the opposition TD criticises what he perceived to be “a disjointed approach between NPHET and the Government” throughout the pandemic.
“My quarrel with government was never on the public health side. Where we differed from and criticised the Government was the slow pace of decision-making, the inconsistencies, the mixed messages, and, at times, the chaotic response from government in not having clear messaging and poorly communicating decisions that were being made. That, for me, is the frustrating part.
“The Government at times saying it was caught off guard when really it should not have been if the type of engagement between the two was as strong as it should have been. It is that lack of planning, cohesion, and decision-making, along with inconsistencies which is where I saw the Government fail.”
Post-Covid, Cullinane identifies waiting lists, eHealth, and regional health as three priority areas for Sinn Féin health policy. “In the context of learnings from Covid, they are the three areas which came up time and again in each of the engagements I had over a six-month time period going out into constituencies, cities, and counties to listen to people. For me, they are the changes we need to make.”
Similarly, the Sinn Féin TD is critical of the failure to deliver a cohesive all-island response to the pandemic. “There was not the type of integration that we should have had in relation to sharing resources in terms of health,” he remarks.
Acknowledging that such as response was hindered by “the nature of politics in the North”, he maintains that a pragmatic approach to the consolidation of capacity as one of the major lessons of the Covid experience.
Reflecting on the decade ahead, Cullinane is now tasked with mapping out Sinn Féin’s alternative vision for healthcare. Discussing his party’s health policy platform, he identifies three distinct elements.
The first is its overarching vision; it wants to transition from what Cullinane labels “a deeply unfair two-tier health service” to a single-tier Irish health service with “healthcare free at the point of delivery, as much as is possible”. The second is an increase in overall capacity to address waiting lists. The third, is more accountability.
Amid several high-profile resignations from the Sláintecare Implementation Advisory Council (SIAC), the Opposition has critiqued the Government’s commitment to Sláintecare, asserting that institutional resistance is threatening its implementation.
While Cullinane concurs that “there certainly is resistance”, he does not believe that it emanates from the vast majority of people who work on the ground in healthcare, who he says are excited about the potential for change in healthcare.
“Is there resistance from some at the top in the Civil Service? Yes, there probably is. Is there also a lack of political will? Yes, there is. I do not believe that Fianna Fáil or Fine Gael were ‘all in’ in relation to Sláintecare. That is problematic. I do not believe that they were truly committed to dismantling the two-tier system. That is in part why they have not focused on removing private healthcare from public hospitals,” the opposition frontbencher insists.
Meanwhile, across investment, decision-making, and talent recruitment and retention, Cullinane identifies several ongoing inefficiencies encumbering the effectiveness of the existing healthcare system.
While Ireland’s spending on services provided by acute hospitals is notably higher than in most other countries and demographic pressures mean public healthcare spending is likely to continue to grow as a share of national income, it is not optimising healthcare outcomes.
“As we get closer to a general election, I can demonstrate that I have the knowledge and we have the policy platform to convince people that we can make serious changes in healthcare.”
“We pay several times over for healthcare, and yet there are huge amounts of money spent in the private sector through the National Treatment Purchase Fund,” the Waterford TD outlines, adding: “We need to be looking at how we spend more of our money in public healthcare, building up our public healthcare, which is essentially what Sláintecare was meant to be about. That is the first thing.
“Secondly, it takes too long to make a decision. It takes too long for things to be done. That is why I think the regional health areas will be really important. To bring about accountable autonomy, where we devolve real responsibility into these areas. All of the elements of healthcare should be integrated under one regional health area structure, with a masterplan for the geographic area.”
Additionally, in interacting with frontline healthcare workers, Cullinane highlights a prevailing pattern of understaffing and overworking amid capacity constraints. The State, he holds, cannot build the type of public health service it desires without recruiting and retaining more staff.
“The first thing that I would do as Minister for Health is very quickly deliver a message to those in healthcare that I want to deliver better public health services and I want them to come and work in our public services. As a quid pro quo, I will do my best to ensure that the issues that are important to them are dealt with, that I listen to them, and I deliver. That means increasing capacity, to make their job easier. Secondly, I would legislate for safe staffing levels, so we have a skills mix and safe staffing framework to look at the science of how many staff are needed in each ward, in each hospital.”
Emphasising the globalised nature of healthcare and the international demand for healthcare staff, Cullinane believes that, at the most basic level, recruitment and retention hinges on valuing the work that healthcare staff undertake.
“If I can give you one quick example of what not to do, it is what the Government did with student nurses and midwives which is to ignore their call for even a basic level of fair pay for the work that they were doing. That was a mistake.
“Mary Lou McDonald and I met hundreds of them over the course of that campaign and they told us that they will not stay and work in the public system, they will leave and go elsewhere at the first opportunity because of the way they were treated.”
Simultaneously, healthcare is a constituent component of Sinn Féin’s raison d’être, Irish unity. Conscious of this, Cullinane references a “job of work to do” to convince moderate unionists of the logic of all-island healthcare. “For me, more integrated care on an all-island basis is very exciting and makes sense. The challenge is how we politically navigate our way through that,” he says.
Advocating for proactive discussion and engagement with citizens and between healthcare professionals, the heath spokesperson emphasises pragmatic service level agreements which are already delivering better patient outcomes on an all-island basis, including at the North West Cancer Centre in Derry and at Children’s Health Ireland, Crumlin.
“The best way to integrate the system and get the best from both is to have dialogue, politically, on these issues, but also to encourage and enable dialogue between healthcare professionals because they have a lot of the answers, they want this to happen, and they can make it happen.
“The two systems, north and south, would have their view, but I think the views of citizens and medical experts would be put front and centre. They will come up with the answers and they will come up with them very quickly. It is not beyond us to take the best from both and deliver better healthcare across the island,” he maintains.
Reiterating his intolerance of pejorative references to the health portfolio as ‘Angola’ or a ‘poisoned chalice’, Cullinane argues that this narrative provides convenient cover for government parties which, he insists, are not committed to a single-tier health service.
“Why would you not want to be in a department where you can make – if you are committed to it – real change; reduce waiting lists, better integrate healthcare, deliver better outcomes for patients, make it a better working environment for frontline healthcare workers, foster a culture to encourage people to come and work in the public system, and have an excitement and an energy about what our new health services would look like? Why would you not want that job?”
While maintaining that he is cognisant that the electorate will determine the shape of the next government, and that there is no guarantee that Sinn Féin will be in that government, he concludes: “I want to be health minister because I think that we can bring about real change and I passionately believe in equality of access to healthcare.”