Enda Kenny gets most of the sound bites right when it comes to government health policy. He repeatedly mentioned "keeping patients at the centre" and the "need to reform" in his interview with Cathal MacCoille on yesterday's 'Morning Ireland'.
But the minute the Taoiseach is probed in any detail on health matters, he flounders and his utter lack of understanding is revealed.
When asked to explain why he was annoyed with the briefing prepared by health officials for the new minister, he launched upon a Bertie-esque non sequitur stating "we are preparing for a budget for 2015 and beyond... the Department of Health... is a very fundamentally important part of government.. the patient always has to be at the centre and there is a €500 million overrun in the Department of Health". Get that?
He then went on to explain the budgetary process whereby Public Expenditure and Reform looks for options from every government department as to how they can live within the expenditure ceiling allocated to them, clumsily avoiding the question in hand.
Mr Kenny then came out with some ludicrous baloney, that Micheal Martin oversaw €3 billion in supplementary health budgets. He did not. Mr Martin was health minister from 2000 to 2004, when €464 million was spent on supplementary health budgets, significantly less than €592 million already spent by Mr Kenny's own government for the same purpose. A sum that does not include the half a billion euro yet to be allocated for 2014.
Bizarrely, when challenged on why his government's efforts to address waiting lists were failing, the Taoiseach responded by saying "waiting lists might get longer, it's a demand-led scheme, obviously you can have a virus, you can have different fluctuations in health systems".
At a high level, the Taoiseach is correct that many aspects of health care are driven by demand, including those presenting to emergency departments and waiting for planned hospital care. However, it is actually pretty easy to predict what services will be needed and where. And one thing is for sure, viruses have absolutely nothing to do with increased hospital waiting lists.
This particular bluff exposed just how little Mr Kenny understands about the health system. And while it is unreasonable to expect the Taoiseach to have a detailed understanding of every policy brief, the fact that he willingly demonstrates such ignorance in relation to one of this government's key policy commitment is extraordinary.
This government prioritised reducing waiting lists as one of the many stepping stones to universal health insurance. It set up a Special Delivery Unit and allocated extra money to specifically tackle the long waits for public patients in public hospitals.
It had some success in the first 18 months, but what we can see in the last 18 months is a creeping increase of the numbers waiting. For example, there were 2,907 more adults waiting over three months for planned hospital care in May of this year compared to a year earlier, while the numbers of children waiting over 20 weeks increased from 721 to 1086 during the same period.
The Irish Nurses and Midwifery Organisation published new figures yesterday showing an increase of 158 people waiting on trolleys in wards and emergency departments when August 2013 and 2014 are compared. The 2014 HSE Service Plan was predicated on a reduction in outpatients, when in fact there has been a 4 per cent increase in outpatients in the first five months of this year. All these show a health system unable to meet the demand of providing more care to more, sicker people, with fewer staff and less money.
But back to the higher level rhetoric. The Taoiseach expressed support for the new health minister, restating the government commitment to replace the current unfair, discriminatory system with one where access is based on medical need, eventually through universal health insurance. Notable in its absence is how they might do this.
However, if any of what is left of their health commitments are to be achieved, then the Taoiseach, the Tanaiste, ministers Michael Noonan and Brendan Howlin all need to assist rather than shaft the new health minister. The most tangible way they can do that right now is collectively to allocate a decent budget to health and progress their commitments to deliver medical care on the basis of medical need.
Sara Burke is a health policy analyst and a research fellow in Trinity College Dublin