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In his time as Minister for Health, the former Taoiseach Brian Cowen once famously referred to the Department of Health as ‘Angola’. This was due to the number of political landmines that were ready to explode in the face of unsuspecting Ministers. The quip is regularly trotted-out by political reporters on the appointment of a new Minister for Health and whenever they encounter their first ‘scandal’.
Some might say that the quip is just that, a quip — a humorous acknowledgement of realpolitik. But it has a troublesome subtext. Encoded within the phrase is the view that politics is a game of musical chairs. All that matters is the next post. The Health Ministry is simply something to be survived on the way to greater things. The important thing is to emerge from the position unscathed, insofar as is possible.
This attitude leads to political caution. The current Taoiseach Leo Varadkar rarely left damage-limitation mode when he was Minister for Health. He was appointed to roll-back on the commitment for universal health insurance (UHI) that was promised in the Programme for Government. The blame was put on Dr James Reilly, who was not perceived as politically-savvy enough to get the reforms through. UHI was an extremely flawed plan, but the failure lay with the Fine Gael/Labour coalition as a whole, not just Dr Reilly. Appointing Leo Varadkar to the role gave the appearance that action was being taken on the failure to implement UHI while, in reality, the Government bought itself time until the next scandal hit Hawkins House.
It is clear the honeymoon period for Simon Harris is long over. The days in which he basked in social media glory during the referendum on the Eighth Amendment must seem a lifetime ago. The budgetary over-run for the National Children’s Hospital led to a no-confidence motion in the Dáil. Although he survived the vote, it came at a time when he was already under increasing pressure with the nurses’ strike and GP protest.
Ministers for Health, and also positions such as the Director General of the HSE, come with huge responsibility and they should be held accountable for their actions. But they only form part of the picture. The big challenge in healthcare in Ireland, as in all countries, is resourcing. And decisions on resourcing ultimately lie with the Department of Finance and the Office of the Taoiseach. The success of Sláintecare lies outside the domain of the Department of Health.
If healthcare was viewed more as an entire Governmental responsibility, rather than the exclusive concern of the Minister for Health, perhaps the view of the role being toxic and something to be avoided could be dispelled. The nature of politics, with its need for scapegoats, makes such a shift unlikely. The Department of Health might recently have moved offices but, for ambitious politicians, it will continue to be seen as ‘Angola’ for some time to come.