Larger budgets are frequently demanded by public institutions as a prerequisite for development and reform. Yet in many cases much can be achieved without any additional funding, and sometimes with less, provided leadership has the courage to shake things up, redeploying existing resources, amend the law…. or just be bloody-minded. Some examples.
The Irish health system has been ranked as the least efficient of the OECD’s 24 countries. From the report it can be deduced that the Irish health budget could be cut by some €4 bn if OECD average efficiencies were achieved and by over €5 bn if Swiss or Australian.
If account is taken of Ireland’s young Irish age profile the per capita expenditure on health is the highest in Europe.
More money for health is not the solution: radical redeployment of resources from administration and support to the front line is. Failure to install a national integrated computer system and ‘lean’ management systems has resulted in a bloated administration that syphons off resources that should be at the front line. Ireland has only 40 percent as many consultants as the OECD average and 50 percent as many GPs. Of the 100,000 plus HSE staff less than 9,000 are medics. Yet there are and over 15,000 managers and administrators, 10,000 general support and over 17,000 ‘other’ 
Sweden, faced with a dysfunctional health system similar to Ireland’s, has privatised much of it since 1994. Swedish authorities set down strict quality standards and are agnostics as to whether care is offered by public or private institutions. Two hundred new private health facilities have been opened and all public hospitals in Stockholm are now under private management. Management contracts are awarded on a tender basis. This brave disruption of the status quo has been termed the ‘Stockholm revolution’.
Ireland and Malta are the last remaining EU countries that require a pregnant woman to carry a foetus to maturity; whether it is fatally malformed or the result of rape. Ireland is the only European country whose constitution refers to the matter. Other dominantly Catholic countries such as Belgium, France, Italy, Spain and Portugal have already rejected church guidance. It is time that Ireland did likewise and permitted individuals to make choices based on their own moral convictions. The battles related to contraception, divorce and marriage have been won. So will the battle to repeal the Eight Amendment.
CARE OF THE ELDERLY
Until relatively recently most people lived out their days and died amongst their family and friends in the familiar surrounds of their home. Now increasing numbers of the elderly are institutionalised and spend their final months or years in alien surroundings. Too often, when close to death, they are moved from their nursing home to an acute hospital. An A&E trolley experience, and possibly surgery or resuscitation, is a prelude to death that most would hope to avoid.
Home care combined with smart technology are now improving the quality of life and independence of the elderly. The prospects of dying with dignity at home are improved and excessive expenditure arising from intrusive and inappropriate procedures and institutional care is curtailed.
Provision has yet to be made in Ireland for those whose quality of life has deteriorated to a totally unacceptable level and who wish no longer to live, but die with dignity. Switzerland has led the way, and since 1942 has developed structures and safeguards that permit those who wish to die to do so without hindrance by the State; peacefully and with dignity. Other European countries have followed suit and introduced a variety of similar arrangements: Belgium, Netherlands, Luxembourg and, last year, Germany. Legislation is at various stages in many other developed countries and physician aid in dying is now legal in 5 US States., and under consideration in most others. It is time Ireland too gave thoughtful consideration to the matter.
Teacher Education Reform
Irish 16 to 19 year-old students have performed badly in a recent OECD study. They were ranked 21 out of 23 in numeracy and 18 out of 23 in literacy. For many years employers have expressed concern about the ability of Irish graduates to communicate. The most successful countries such as Finland, the Netherlands, Japan and Korea have focussed their strategy on improving the quality of teaching and have reformed their policies for teacher education. Finland restricts the number admitted to teacher education by a series of most demanding tests to eliminate those who are unlikely to be good teachers and then looks after those admitted in a caring way. In Finland teaching is a most highly regarded profession.
A study in Australia has highlighted that increasing teachers’ pay or reducing class size has an insignificant effect when compared with focus on developing those teaching skills which can result in excellent teaching. Another study of 2.5 million students over two decades has shown that a good teacher improves the prospect of a student going on to college. A good teacher increases earning prospects: swapping a teacher at the lower 10 percentile with one of average ability increases the collective lifetime earnings of a class by $1.4 million.
Monitoring the performance of teachers is shown to be vital in reaffirming good teachers and giving an early warning for teachers in difficulty. The OECD notes that Ireland has no performance-managed system for individual teachers and in this regard gives Ireland the lowest ranking of its 24 countries.
Reform of teacher education, along Finnish lines, and introducing systems to monitor teacher performance represent the most cost effective initiatives open to government.
Restructuring National Council for Curriculum and Assessment
Ireland, unlike most other countries, permits the teacher unions to play a dominant role on its curriculum council. Over the years the teacher unions have had a most unhealthy influence on curriculum development…or rather the lack of it. Removal of the teacher unions from the National Council for Curriculum and Assessment and reducing its size from 25 to 11 members would be a key step towards curricular reform.
If low literacy levels are to be addressed language policy must be reformed.
Policy for restoration of the Irish language has been a demonstrable failure and should be changed fundamentally. The policy of compulsion, introduced with the founding of the new State, and still in force, has been counterproductive. Interest in and good-will towards the language flourished in the early 1900s under British rule when there was neither compulsion nor the jobbery associated with the language that emerged after independence.
As an initial step the compulsory study of Irish should no longer be a requirement at post-primary level. Irish language resources should be directed to those students who opt to continue study and resources should be redeployed to improve linguistic abilities in modern European languages…and perhaps Mandarin.
Funding: Contingent Loan System
Harsh funding cuts during the recession have resulted in slippage in the international reputation of Ireland’s universities. Australia, and subsequently many other countries, have replaced public funding with a Contingent Loan System. Students receive loans to cover the cost of their higher education and start to repay these loans when their earnings rise above a certain threshold.
Australia has demonstrated that this system works well and encourages the participation of low and middle-income families.
Students with loans become demanding clients: the source of funds. Australian universities have been transformed as a result of their efforts to respond to real market pressures.
Reform of University Governance
Irish university governing authorities are large and cumbersome and dominated by internal members. The UL governing authority has 34 members, UCD 41.
Ireland should reform the governance of its universities as Denmark has. Sweeping reforms were introduced in Denmark in 2003 that have transformed not only the governance of the universities but the universities themselves. The US corporate approach has been adopted.
The Board of Governors consists of 11 members of whom 6 are distinguished external members with expertise related to the declare mission of the university. The Board has the power to appoint or dismiss the Rector. The Rector has the power to appoint or dismiss the Deans.
In attempting to reduce Green House Gas (GHG) emission the EU has focussed on replacing fossil fuels with wind and solar. This has driven up the cost of EU energy and reduced competitiveness. The US on the other hand has facilitated fracking. Gas and oil prices have plummeted. Energy providers have switched from coal to cleaner, cheaper gas and as a result the US has been three times as successful as the EU in reducing its GHG emissions. US electricity prices are now typically half those in the EU: a win/win for the US and a loose/loose for the EU. The Chinese are probably on the most rational and cost-effective long-term strategy with focus on nuclear, combined with renewables: 35 nuclear plants have been commissioned, a further 20 are under construction. More are planned.
Ireland has just committed to an EU 2030 target to reduce its GHG emissions by 40 percent from 1990 levels. This decision was taken without general awareness of the costs or consequence.
It is doubtful that it is feasible for Ireland to achieve the target. It is certain that major cost to the tax payer and loss of competitiveness will arise in attempting to do so.
Agriculture is responsible for most of Ireland’s GHG emissions (33 percent). Cows produce almost all of it, so the only way to make reductions in this sector is to reduce numbers. Plans are otherwise.
So if beef and dairy production is to be protected the additional burden falls on the industrial, business, transport and residential sectors.
Industry is already bearing its burden of the climate change agenda and in addition suffering from the high cost of Irish electricity, which is typically twice as expensive as in the US. Business leaders are becoming increase concerned that the cost of the climate change agenda in their sector may be of the order of €0.5 bn per year.
Transport emissions tend to go up as the economy grows. This trend can only be reversed with major investment in public transport and infrastructure likely to cost in the order of €1 bn per year… at the expense of the travelling public and the tax payer.
Residential energy use can be reduced, through a large-scale home-insulation programme and other measures. This too would require major investment in the order of over €1 bn per year…at the expense of owners and the tax payer.
There has been little if any discussion about the major financial burden the adoption of these GHG reduction targets imposes on the people of Ireland. While comprehensive official estimates of the cost of meeting the 2030 GHG targets have yet to be provided, it is clear that they will be substantial: informal estimates suggest figures ranging from €30 bn to €50 bn. If correct these represent costs between €15,000 and €25,000 per Irish household and in comparison make Irish Water charges look like small change. A report that has just been published by the Dusseldorf Institute for Competition Economics puts the cost to 2025 of Germany’s green agenda at a staggering €520 bn for the energy sector alone,. Peter Altmaier, Germany’s Chancellery Minister has warned that the cost of the Energiewende
could “cost the country around one €1,000 bn euros by 2030. ” This gives credibility to the comparably staggering estimates for Ireland.
Recent studies by eminent scientists are now raising questions about the validity of the models upon which global warming predictions have been based,. Indeed, actual temperature measurements have so far failed to increase as rapidly as predicted. While there is no doubt that global warming is taking place, there is reason to be sceptical about alarmist projections of the rate of warming and the extent to which GHG emissions contribute.
The decision of the EU to impose upon the Irish people a programme that is likely to require expenditure comparable in magnitude to one quarter of the national debt should not be accepted as readily as it has. After Japan Ireland’s per capita debt is still the highest in the world. Until there is clearer evidence that the temperature growth predictions based on rather primitive computer models are credible, and not as alarmist as many reputable scientists believe, Ireland would be wise to hasten slowly in allocating additional funding to the climate change agenda.
If it is confirmed that the level of expenditure required to meet the 2030 target set by Brussels is in fact of the order of €40 bn, then reneging and paying the EU fine, estimated at €5.5 bn, may be an option worth considering.
Since 1950 almost all the countries of Europe, with the exception of our nearest neighbour, have introduced new constitutions, new electoral processes and new systems of national governance: systems geared to the need for proactive response in a fast-moving world. Those that had electoral systems similar to Ireland have long since abandoned them: leaving Ireland alone with Malta struggling to govern itself under an archaic system.
The new European democracies have shunned the Irish system of election and national governance. All have adopted versions of the Scandinavian List System whereby members of parliament are elected partially from local constituencies and partially from party lists of individuals that have proven records of distinguished national and international achievement: many from business and the professions. When a government is being formed in these countries the Prime Minister has available a rich pool of proven talent from which to select a Cabinet.
In most advanced democracies such as Norway, Sweden, Switzerland and the Netherlands a clear distinction is also drawn between the executive (Ministers) and the legislative branches of government. As a result, those who are appointed to executive roles as Ministers do not have conflicting parliamentary duties: their challenge is not to be re-elected but to make the right things happen. Without the distraction of constituency and legislative affairs Ministers, and the Government as a whole, can focus on their demanding executive responsibilities and, when necessary, take timely and unpopular decisions that are in the best long-term interests of the country as a whole.
While our electoral process results in the election of a small number of excellent people the pool from which a Taoiseach draws when forming a Government is limited indeed, because in effect it bypasses leaders of enterprise and the professions with the necessary strategic management skills and experience. Our system of election draws over 80 percent of the Oireachtas from a group of some 1000 people: the members of local authorities. While a county or city council would certainly be a source of pleasant and well-intentioned people it would be an unlikely source of the experienced talent required to strategically guide national policy and effectively manage a multi-billion budget. Every democracy needs participation from the parish pump in its parliament, but when all of its members are drawn from that same source, to the exclusion of the necessary available talent, the outcome is as we have it: not good.
In 1992 New Zealand took the bold step and adopted the List System. New Zealand today is one of the finest examples of a well-run caring democracy. Ireland should follow.
13 October 2016
Dr Ed Walsh is the founding president of the University of Limerick
 OECD health data, 2009.
 Paul Redmond, Expenditure and outputs in the Irish health system: a cross country comparison. Public Policy.ie c 2013. Age demographic adjustments are author’s own calculations. The denominator for Ireland is GNP.
 HSE National Service Plan
Healthcare Systems: Sweden & localism –an example for the UK? Elliot Bidgood . Civitas. October 21, 2013
 Carl O’Brien. OECD finds literacy an issue in Irish education. Irish Times. 30 Jan. 2016.
 Flynn, Sean. Concern at writing ability of graduates. Irish Times. 14 Jan. 2013.
 Ripley, Amanda. Smartest kids in the world: and how they got that way. Simon and Schuster. 2013.
 Teaching the teachers. Economist. 11 Jun. 2016.
 Million reasons to improve teacher quality. Economist website. 16 Oct. 2013.
 Reidy, Bill. Teachers need regular performance reviews. Irish Times. 21 Jan. 2014.
 Boland, Rosita. Can anybody truthfully say that Irish is a necessary language? Irish Times. 30 May 2016.
 University Evaluation 2009, Evaluation Report, Danish University and Property Agency, Bredgade 43, DK – 1260 Copenhagen, Denmark
 IPCC (2013), Fig. 11.25(a).