New minister must realise health service can't take more cuts
It's reshuffling season and political news coverage is filled with speculation on who might be moved where. Serious business is still being done by government, evident this week in Minister Frances Fitzgerald's and the Garda Commissioner's apology to the Roma families, Minister Brendan Howlin's announcement of the abolition of FOI fees, and Minister James Reilly's launch of a compensation scheme for victims of symphysiotomies.
Yet despite the continuing work of the Cabinet, there are endless column inches and broadcast time spent on the imminent human resources rejigging, which ultimately lies in the hands of the Taoiseach.
So is a cabinet reshuffle just superficial optics or does it really matter who gets which ministerial posts?
When it comes to the health department, it is patently clear that it really does matter who is the minister. We know this because of the depth and breadth of influence that they have on shaping the policies pursued by their government and what actually happens to the health system during their tenure.
Looking back on the past five health ministers demonstrates their influence. Mary Coughlan's two-month stint in Health early in 2011 is barely even worth a mention. And it's hard to remember what Brian Cowen did in the health department during his two brief years there, in the late 1990s, apart from ghettoising it as 'Angola'.
Micheal Martin may well be recognised for introducing the smoking ban but his primary legacy is his failure to reform the Irish health system. In the years when money was being thrown at the health services, he published endless reports but delivered on few of them, except planting the seeds for the exceedingly defective formation of the HSE. Mary Harney took on the mantel of the HSE's foundation, appointing a banker as its first chair.
From before its start on January 1, 2005, it is a classic casebook study on how not to 'reform' a health service. For its first eight months it had no CEO, and for the last nine years there has been the never-ending restructuring of the HSE's services and recasting of its senior managers.
Harney's commitment to Boston as opposed to Berlin, her belief in market and private forces set the agenda for health policy under her seven-year tenure, further institutionalising the unfair public and private mix of Irish healthcare.
She should be given credit for the reform of cancer services under her reign, as well as establishing HIQA, which has become the acceptable face as the regulator of many aspects of the health and social care system.
However, all three of them were in office during the 10 years that the health budget quadrupled, and their collective No 1 crime was not to use the colossal increase in resources to deliver high-quality care and universal access to health services. If James Reilly is reshuffled sideways, or out of Cabinet, he will most likely be remembered as the minister who blundered his way through his flawed programme of health reform, his political interference with the selection of primary care centres, the subsequent resignation of junior minister Roisin Shortall and his failure to keep the health budget in line.
While the first three are warranted, the latter is unfair as he inherited the post in the midst of the most severe economic cutbacks to the health budget.
Internationally, in the public health world, Reilly will be credited with his battle against tobacco, which he championed during the Irish presidency of the EU in the first half of 2013 and now evident in his plans for Ireland to be the first European country to introduce plain packaging for tobacco. In time, if (and it's a very big if) government delivers on its commitment to provide medical cards on the basis of medical need, Reilly might be remembered as the minister who sowed the seeds for the actual delivery of universal access to healthcare in Ireland.
The next health minister will inherit all the pitfalls that come with the health department – how to juggle service delivery and future planning, or even reform, with never-ending service failures and human crises which constantly distract from good health system management.
The foremost job of the next health minister, even if it is Reilly, is to prevent any further cuts to health.
Health services, in their current configuration, cannot take any more budget cuts on top of billions already stripped out of the system.
Whomever is in Hawkins House has a great opportunity to be a truly reforming health minister, to really positively influence Irish health policy and services, now and in the future. Let's hope Enda Kenny chooses wisely.
Sara Burke is a health policy analyst