Merry-go-round of junior ministers must be retuned to ensure greater cabinet harmony

Both White and Lynch were touted as front runners for promotion to the cabinet table, yet only White got there. A relative newcomer to political life, White was elected to South Dublin County Council in 2004 and to the Daíl in 2011. He willingly filled the embarrassing vacancy as the junior health minister with responsibility for Primary Care when Roisin Shortall resigned on a position of principle, in September 2012. One of Shortall's reasons for resignation was that she was unable to deliver key government commitments as she was consistently undermined by her senior minister, James Reilly.

The key primary care commitment in the 2011 Programme for Government was to give free GP care to all by 2016, prioritising the sickest by giving it to those with long-term illness by March 2012 and to those using high-tech drugs by March 2013. These steps were not delivered, allegedly on the basis that they were legislatively too complex. Instead, Budget 2014 promised to give free GP care to under six-year-olds. White assured that these young children would have free GP care by now, and only recently acknowledged that it would not happen until autumn, and even that seems optimistic.

Technically, White as minister for primary care was in charge of medical cards. As the fiasco around the withdrawal of discretionary medical cards gained traction over the last year, White insisted that there was no change in policy and no such thing as discretionary cards. The belated cabinet decision in May to give back 15,000 discretionary cards and their commitment to deliver medical cards on the basis of medical need was significant egg on White's face.

White, alongside Reilly, the Taoiseach and other government colleagues, did provide the sure-footedness needed to get the sensitive Protection of Life during Pregnancy Bill through to Dail. And he eventually got GPs to the table to discuss a new contract. Although White failed to deliver on critical primary care commitments (on free GP care and a new GP contract), he got rewarded with a senior cabinet post.

Meanwhile, Lynch is reportedly happy to stay at junior ministerial ranks in order to deliver on her health remit. Kathleen Lynch is a good performer, is well on top of her own brief and is regularly trotted out to defend much of the indefensible aspects of government policy.

Yet, in her three years as minister, very little has changed for older people and people with disabilities except the increasing fear of the withdrawal of essential services driven by the interminable, arbitrary cuts to health and social care. In the area of mental health, Lynch has been a strong advocate for delivering A Vision for Change – the 2006 mental health policy. Central to realising this 'vision' is the so-called new money allocated to new mental health posts.

Despite this Government's promise of an additional €35m a year to fund these new posts, just 80pc of the 2012 and 2013 posts have been filled. The extra annual allocation for 2014 was cut to €20m, and not one of the 280 posts promised for this year has been filled pending 'a comprehensive workforce analysis'. Presumably none of the earmarked €20m is yet spent. In fact, there are now significantly fewer mental health staff than when Lynch took up her post. The Mental Health Commission has warned staffing shortages have ground any progress in mental health services to a halt and are in danger of 'stagnating and moving them backwards'.

Like White, Lynch's delivery on reform was in short supply and now she has the additional task of getting GPs to agree to a new contract and introducing the free GP care to our youngest and oldest before the next election.

In effect, it is the senior minister that calls all the shots, so it will be most interesting to see where the responsibilities will land for public health given the haggling between ministers James Reilly and Leo Varadkar over who gets which aspects of public health policy. Moving 'responsibilities' around junior ministers requires the mere stroke of a pen and in effect means nothing, whereas reallocating senior departmental responsibility needs a 'delegation' and just distracts from the issue with the very time consuming reorganisation of government departments.

Junior health ministers' existence to date proves they are just a springboard for the politically ambitious to cabinet and/or a last ditch attempt by the political powers that be to save some key seats in the next general election. If junior ministers are really there on the basis of merit, with the intent of bringing about positive change, they have less than two years to prove themselves.

Sara Burke is a health policy analyst and a research fellow in Trinity College Dublin. @sburx