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A good start but Dr Reilly has huge task

An old joke about our current broken health system told, ironically, by former minister Mary Harney, was: Question: 'How do you reform our health service?' Answer: 'Well, I wouldn't start from here.'

Well, James Reilly made a good start in his mammoth task this week when he met the HSE's board, thanked the members for their hard work -- and essentially told them their days were numbered.

He will shortly change the membership of this board, which sits on top of a bloated, bureaucratic and inefficient health organisation whose existence and structure lies at the root of many of the problems in the health service.


Dr Reilly has promised to appoint new members to this board, not, he's keen to point out, because of the way the previous board has done its work -- but because he's eager to start making changes.

In promising to replace board members, he has stressed that this will not be a political move by the new Government.

The intention is to pick the best person as his planned health reforms take root.

In this much-vaunted era of 'new politics', the public will hold the minister to this promise.

And there's more.

As health reform progresses, the much-unloved HSE is to be done away with.

It will be subsumed into the Department of Health, the planned new universal insurance system and other structures.

Hospitals will no longer be run by the HSE and will be made independent.

Staff will be redeployed within the system.

Most people will rightly give three cheers to the demise of the HSE.

But how do we know old attitudes and old bureaucracy and inefficiency won't re-emerge in a new guise?

It's one of many challenges facing the new minister for health and his government.

James Reilly has the wind of public opinion firmly behind his back with his pledge to reform our sick health system.

The healthcare changes he is planning are the most radical in the history of the State.


We are to get universal access to hospital treatment, equal access to hospital care, free GP care, compulsory insurance payments for many and big changes to how the system is run.

The scope of change is radical and to the average punter, potentially bewildering and confusing.

There are also questions about how this brave new world will be funded.

Who will end up paying for it? How much we will end up paying?

Will and if the cost of the system will eventually go through the roof and the level of benefits will be reduced as a result.

The biggest question is will it all work and will we have the guts of a new efficient service in place in five years time?

Some detail has been provided, but all in all, the public probably at this stage only has a vague notion of what's in store.

The public certainly doesn't want to look a gift horse in the mouth, and the new minister has to be fair, only been in office for three weeks.


Most people will wish Dr Reilly well in his ambitious task, but they will want to see more detail and timelines fairly quickly as we enter this brave new world.

The minister has made a good start with changing the HSE board -- let's hope he builds on this. And to begin with, he must insist that the revamped HSE board, while it continues to exist, should meet in public.

Niall Hunter is editor of irishhealth.com