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And now for the hard part on health

Health Minister James Reilly's decision to force the resignation of the HSE directors is unlikely to do him much, if any, political damage.

After just six years in existence, the HSE has managed to become massively unpopular. "Requesting" the resignation of its directors, as the minister did yesterday, will play well with public opinion.

It's not difficult to see why. This year the HSE will require almost €14bn of public money. The government's health budget has risen almost five-fold over the past 15 years. Yet despite this massive increase in health spending, improvements in health care have been painfully slow in coming. Every winter we are treated to the sight of hundreds of hospital patients on trolleys, more than 50,000 people are on hospital waiting lists, and all too often access to much-needed treatment depends on the patient's ability to pay rather than their medical condition.

The departing directors will be replaced by an interim board made up of HSE executives and senior officials from the Department of Health. According to the minister, the interim board will remain in place until he introduces new legislation to abolish the HSE later this year. It will then be replaced by a new structure directly accountable to Dr Reilly. This is being portrayed by the minister as the removal of an unnecessary layer of bureaucracy.

In practice, former Health Minister Micheal Martin's decision to hive off the operation of the health service to the HSE is being reversed. While we will have to wait to see the precise details, it is already clear that Dr Reilly intends to be far more hands-on than his predecessor Mary Harney.

All of which begs the question: If the HSE and its existing board was going to be scrapped in a few months' time, why go to the trouble of getting rid of the directors now? Behind all of the minister's fine talk of greater accountability, it's not difficult to detect more than a hint of grandstanding in yesterday's events.

That was the easy part. Now that he has very firmly placed himself in the driving seat, Dr Reilly will find himself being held directly accountable for the many failings of the health service. Without the buffer of the HSE he will be blamed every time something goes wrong.

If the minister is to deliver on his promises of reform he will have to face down a formidable array of lobby groups, including hospital consultants, nurses, GPs, pharmacists, and local pressure groups seemingly determined to retain hospital facilities in every town and village in the country. It's when he tackles these groups that Dr Reilly's mettle will be tested.

The removal of the HSE directors went remarkably smoothly. All of the directors went without any fuss or bother. Normally ministers find it virtually impossible to remove the directors of state bodies, even those who have been appointed by their own party. This should make Dr Reilly very worried. Could it possibly be that, mindful of the problems which lie ahead, the HSE directors were only too glad to hand over this particular political hot potato to the eager new minister?

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