Health system in flux - Challenges greater than ever before

Former Taoiseach Brian Cowen’s colourful description of the Department of Health as “Angola”, because administrative “landmines” could explode without warning, is so very memorable because it had, unfortunately, more than a sting of truth in it.

Mr Cowen was describing a department that was a relatively peaceful if cumbersome and inefficient monolith. It may have been chaotic and waiting lists were far, far too long but at least we thought we could afford it. We could, we were assured, spend it because we had it.

The department’s handmaiden, the HSE, was and is, thanks to Bertie Ahern’s calamitous 2004 decision to veto Mary Harney’s plans for redundancies when the HSE was established, top heavy with administrators. Too much was spent on paperwork and not enough on medicine. Despite those challenges, and an acrimonious nurses’ strike, Mr Cowen’s problems would struggle to get on incumbent James Reilly’s priority list.