Enda has given his golden boy Harris a real hospital pass
The appointment of Simon Harris to the searingly hot seat of Health Minister has all the appearances of a serious political mistake.
To be fair, Fine Gael's shooting star has blazed a trail. His adept playing of a sweeper's role in the European elections marked him out from other backbenchers. His reward was a junior ministry at Finance, where he benefited greatly from Michael Noonan's generous delegation of duties.
But Taoiseach Enda Kenny hasn't done him any favours by parachuting him into Hawkins House. It is a political minefield and the most seasoned campaigners have wilted in the white heat of battle. That is why it has to be asked: what does this 29-year-old raw recruit, with a journalism degree, know about the complexities of acute hospital care or tertiary medicine? What skills or experience has he to draw on to deal with a myriad of vested interests, protecting administrative empires and massive budgets?
Then there are the vicious battles to protect a local patch or professional service. These demarcations make flexibility very difficult. It'll take Mr Harris years to absorb the subtleties of primary care. Then there are the technological and investment issues. You need time to build up the relationships essential to get things done.
Leo Varadkar is bright, with a medical graduate degree, and he had worked on the front-line of the health service. About two years into his portfolio, he began to show an awareness of the complexities involved. Gone was the earlier enthusiasm, but it was replaced with a steely realism born out of experience. He should've been kept in the post, whether he wanted it or not.
After Fine Gael's shambolic misadventure on universal health insurance, James Reilly left a difficult legacy as a result of years of austerity. A fog of confusion followed - there had been the dismal local elections campaign, and the controversy over the removal of discretionary medical cards.
Mr Kenny's riding instructions to Leo were to hold tight on the reins and keep health controversies out of the media limelight.
Over the two years, another €800m was allocated. But there were disputes over conditions and hours worked by nurses, and the trolley crisis dragged on. All of this meant that concessions on promotions and pay had to be made. There was precious little good news.
But Mr Harris's inheritance from Mr Varadkar is hardly much better. For instance, trolley counts in April peaked at an unacceptable 533; waiting in-patient lists (more than six months) worsened from 9,643 in 2011 to 26,838, with a record almost 400,000 people on out-patient waiting lists.
Proposals for structural reform to effectively abolish the HSE persisted. The idea focused on the establishment of seven hospital groups and nine community health organisations morphing into trusts.
They would compete for finance, based on activity levels and efficiency.
But the political fixation with organisational reform is misguided.
The latest example is a plan titled 'Future Health: A Strategic Framework for Reform'. It allows for the setting-up of independent, autonomous trusts. But these will add layers of top management (each organisation will have a CEO/CFO) and will simply spark new turf wars. Britain's NHS is moving in the opposite direction, merging hospital and community care functions.
Developing national strategies on cancer or maternity care becomes almost impossible amidst a new labyrinth.
Mr Harris's initial forays smack of high hopes for big-picture solutions. There may even be summits in Dublin Castle and a magical 10-year national plan
His ambition masks a naivete. The first thing he needs to do is reach a political cross-party accord on levels of Exchequer funding for Health beyond the 2016 allocation of €13.1bn.
We also have to allow for the cost to the Health budget of an extra 20,000 OAPs per year. This has never been benchmarked.
It is also crucial that the number of hospital beds required nationally be settled on and provided for. For instance, in 1980 there were 18,000; now we have between 14,000 and 15,000. Comparing that ratio to the current population, we should ideally have at least 24,000 beds. This is reduced through advances in day surgeries and shorter hospital stays. All the same, experts claim we need an additional 2,000 beds.
The cost of an acute hospital bed to the State is €6,000 per week, whereas high-quality nursing home care costs €1,200 per week.
Estimates confirm we need an additional 8,000 'Fair Deal' beds by 2021. Many elderly patients are subject to emergency department trolley delays due to a lack of either community care or nursing home facilities.
The radical shift to enhance primary care, with 80 additional primary care centres, is welcome.
The best ideas I've heard on health policy/delivery came from past and present HSE bosses, Brendan Drumm, and incumbent Tony O'Brien, along with Frank Keane (HSC head of surgery). Their breadth and depth of knowledge, based on front-line experience, is peerless. They all identify primary care as the priority.