Sláintecare has become a byword for progress in health services but this week the reality behind the slogans came into focus.
Two top officials have resigned; moves variously described as a “shock” and “very serious” by politicians familiar with the reforms.
Dr Tom Keane, chair of the advisory council, left a pointed resignation letter in which he said “requirements for implementing this unprecedented programme for change are seriously lacking.” How has a project with unprecedented cross-party and cross-health sector support arrived here?
Sources say there are questions about how the power-sharing jigsaw between the HSE, Department of Health and Sláintecare actually works. A progress report highlighted struggles in getting people to take responsibility for projects even around the spiralling waiting lists.
The move from hospital care to community and away from private insurance cuts across a lot of fiefdoms. It requires sustained, targeted investment which sources indicate is not accepted by everyone with their finger on the purse-strings.
Changes like giving GPs better access to diagnostics or running midwifery clinics in the community are claimed as part of Sláintecare. But some have said without the pandemic even these changes would still languish on a shelf.
Patients probably don’t care why these changes have happened, just relieved they can access care more quickly. But others are worried.
Sinn Féin health spokesperson David Cullinane says the departures came as a "shock".
"We need to find out exactly what happened, but I think more importantly we need to put a focus on how we can transition to universal health care, and how we can achieve what we want to see, which is an Irish National Health Service," he said.
Roisin Shortall, Social Democrats co-leader and former chair of the all-party committee which created Sláintecare, described the resignations as “a very serious development”.
We need to see real reform and fundamental changes in how we provide healthcare services. 🏥— Social Democrats (@SocDems) September 9, 2021
Ministers are happy to use Sláintecare as a brand, but this has to be about more than a rebranding exercise.@RoisinShortall earlier on Morning Ireland 👇 pic.twitter.com/j8QWynbns6
The programme should be moved to the Department of the Taoiseach as originally planned, she told RTÉ.
The resignations would appear to indicate that people, put into these jobs for their expertise based on success in previous challenging roles, are not being heard.
So while it is cheering to hear over a million people were given individual health identifiers as part of e-Health changes, what of the IT projects deemed “significantly impacted” by the cyberattack?
The attack happened five months into the six-month review period - what was happening before the hackers saved some blushes?
Five years ago maternity hospitals in Cork and Kerry were the first to offer electronic health records to patients; until today just two more hospitals have joined them.
Unless Sláintecare leaders are given powers to back up the slogans, other key reforms could face a similarly limited future.