The year ahead will be the big test of Leo Varadkar's metal as the health minister
The Irish health service starts off 2015 in a better place to where it was a year ago. There are two new, bright, competent, younger men in charge. Leo Varadkar as minister and Jim Breslin as Secretary General in the health department.
For the first time since 2009, the health budget is not being cut. Leo Varadkar has garnered much-needed cabinet support and critically the backing of the Economic Management Council. He has proved himself a steady, slick tiller at the top, particularly when contrasted to his predecessor, James Reilly who proved inept at every turn. Minister Kathleen Lynch has a broader remit than a year ago, responsible for primary and social care including mental health and disability services, and is performing like someone who has recently qualified for the senior team.
HSE director general, Tony O'Brien, has proved himself a solid pair of hands during turbulent times, providing much-needed principled leadership, particularly in the area of improving quality and prioritising the care experience for those who receive and provide services for the HSE.
Ministers Varadkar and Lynch, as well as O'Brien, were each refreshingly honest in response to the expose of abuse in Aras Attracta and another near miss with an expectant mother in Portlaoise hospital in early December, demonstrating zero-tolerance for poor care and determination to learn and to make sure such horror stories do not recur.
Of course, they are all still faced with enormous, potentially insurmountable challenges. The health budget will not be cut in the year ahead but it is not enough to even meet population growth and demographic demand in 2015.
Intractable issues such as the high numbers of trolleys in Emergency Departments, of delayed discharges, of public patients waiting for diagnosis, outpatient, inpatient and day case appointments, the thousands of older people now waiting for a nursing home bed, of incalculable levels of unmet need.
None of these issues have gone away and each of them are more severe now than a year ago. However, the trio of Varadkar, Lynch and O'Brien, have as good a chance as any of making credible inroads on areas that all their predecessors have failed.
Politically, they have to make inroads as the next election looms (my guess is it won't be 'til 2016) thus giving them a year to show some tangible improvements in the health system. There is a risk of course that the relentless and arbitrary cuts imposed over the last six years are just too much to overcome and it won't be possible to improve the situation in any of these high profile areas.
There are now 50,000 people waiting over one year for a first outpatient appointment with a specialist. This is not a good scenario, as it represents one per cent of the population and is a political nightmare for every government candidate in every single constituency.
So what can our health leaders be expected to achieve in the year ahead? The long awaited and undelivered free GP care is a make or break issue for the ministers. The Programme for Government said free GP care would be in place for everyone by 2015. If they fail to deliver this most minimal form of universalism to under six year olds and over 70s in 2015, their credibility will be shredded.
Central to achieving this is reaching agreement on the new GP contract. Given that Universal Health Insurance is long dead in the water, if government can't realise free GP care for the youngest and the oldest of the population, they will have zero integrity in the run up to the next election.
Minister Varadkar has prioritised reducing the numbers of delayed discharges and has a budget of €25 million to do it. It is not enough but if he can make some progress in the early months of 2015, this should have a knock-on impact on both the numbers waiting in Emergency Departments and for nursing home beds, which in turn could free up much-needed beds for elective care which could bring down waiting lists. All of this is very conditional on their strategies working and the system not being overwhelmed by demand.
Given the plethora of exposures of poor and sometime fatal care in the health system in 2014, evidenced in the number of high profile maternal and baby deaths in our maternity units, the abuse in a HSE care home for people with disability, the deficiencies in the ambulance services, the health service has to be seen to hold staff to account and to improve patient care, safety and quality of care. Real, tangible improvements have to take place in these areas as well as in others such as mental health and chronic diseases.
The 2015 Primary Care Operation Plan commits to 'introduce service improvements in relation to medical card eligibility assessment, medical card provision and reimbursement' and to 'implement the recommendations contained within the Report of the Expert Panel on Medical Card Eligibility, 2014'. The plan is predicated on a reduction of 55,000 medical cards in 2015, presumably based on assumption that that 55,000 people will no longer qualify for medical cards on the basis of low income as more people return to work.
However, there are higher numbers of discretionary cards now than there has been at any time since 2012 and that is likely to continue. The withdrawal of medical cards from sick people could have brought the government down, but their u-turn and the Keane report saved it and they don't want any further backlash on medical cards in the run up to the next election.
The next general election may be the first time in the history of the State that all parties will campaign for universal health care. It will be really interesting to see where the government parties stand in their health manifestos and equally intriguing to see if and how Fianna Fail, Sinn Fein and the other parties flesh out their health policies. While Fine Gael and Labour have failed to deliver on most of their key commitments made in the last election, at least they both produced detailed health proposals. None of the other parties have done that.
It was obvious the moment he was appointed that the health ministry could make or break Leo Varadkar's political career. So far, it has made him, he has risen to the task, but next year will much more interesting. 2015 will be much harder, a real test of which direction the health services take and of the minister's metal.