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Real problems remain in our health service

In the end, the only real surprise about junior health minister Roisin Shortall's resignation was that it took so long.

The relationship between her and Health Minister James Reilly had clearly become toxic. However, the problems at the Department of Health, which controls an annual budget of almost €14bn, haven't gone away.

Ever since Ms Shortall's extraordinarily equivocal speech in "support" of the Health Minister during last week's Dail debate on the no-confidence motion tabled against Dr Reilly, it was clear that something would have to give. Any remaining cohesion at the top of the Department of Health had irretrievably disappeared. One or both of them had to go.

While Ms Shortall's resignation solves the short-term problem created by the breakdown in their relationship, fundamental problems remain.

By the end of August the Department of Health was heading for a full-year budget overrun of €500m. This led to the botched announcement, with Dr Reilly nowhere to be seen, of €130m of spending cuts by the HSE on August 30.

Eighteen months after he took office it is clear that his stewardship of the Department of Health has fallen far short of what the Irish people are entitled to expect. It is now clear that the 2012 health budget, which included €112m of savings from the HSE's drugs bill and an extra €75m in revenue from charging private health insurance patients treated in public beds, was based on a false prospectus.

Nine months into the year, the minister has yet to reach a deal with pharmaceutical companies on drug prices while the proposal to charge private patients for public beds has the potential to turn the tide of people giving up their private health insurance, over 200,000 since 2009, into a tsunami.

By comparison, disagreements over what criteria were employed to decide the location of a handful of primary care facilities, the ostensible reason for Ms Shortall's resignation, pale into insignificance. It is almost as if Dr Reilly and Ms Shortall, overwhelmed by the sheer magnitude of the problems facing them, chose to confine their differences to a few relatively small, easily-understood issues.

Ms Shortall's successor, Alex White, would do well not to allow himself to be distracted by such trivialities. Our health service is in crisis. Funding will remain tight. We must learn to do more with less. If he is to succeed where his predecessor failed, Mr White must keep his eye firmly on the big picture.

Irish Independent