Since I was appointed Minister of State at the Department of Health last October, many have asked me whether I felt I had been handed a "poisoned chalice", or indeed a "hospital pass"?
A previous minister for health is said to have referred to his department as “Angola”, on the basis that it was filled with unexploded landmines.
Health is neither Angola nor a poisoned chalice. Remarkable changes in our social and individual wellbeing have been effected through health policy.
Average life expectancy in Ireland is at its highest ever and is above the EU average. Death rates from a variety of life-threatening conditions have fallen, in some cases halved, in less than 20 years.
The impact of diseases and conditions that damage quality of life is being mitigated year on year.
These developments owe much to advances in medical science and to the effectiveness of our medical professionals. But they are also due to policy decisions to fund new treatments and services and to deliver them to the public in as effective a way as possible.
Holistic approach
My area of responsibility is primary care, the first port of call for citizens seeking access to the health services. At primary care level, there is a holistic approach to health and wellbeing.
As well as being treated when they are sick, people receive advice, support and guidance to help them avoid illness in the first place.
It therefore makes sense for people to have easy access to their GP, to have health problems identified before they get serious and to get help on how to manage aspects of their lifestyle before they cause problems such as diabetes and other conditions.
It not only makes sense for individuals, it makes sense for government too. Primary care is a lot less expensive than high-tech hospital care. If illness can be avoided or managed before someone ends up in hospital, this results in a better outcome for the patient and is a more effective use of scarce resources.
This is why in opposition the Labour Party championed the idea of universal free access to GP care and why, along with our Coalition partners, we have pledged to introduce it.
Translating sound policy objectives into practice is the real business of government, and implementing universal GP care is a case in point. The idea was to start with claimants of free drugs under the long-term illness scheme. A year later, access to primary care without fees would be extended to claimants under the high-tech drugs scheme. Subsidised care would be extended to all in the next phase and, finally, it would be free to all.
It has become clear to me that this approach is too complex and likely to be extremely cumbersome in practice. It would mean introducing new legal and administrative arrangements to ensure free GP care went to those for whom it was intended, potentially even requiring ministerial regulations setting out the diagnostic basis for each chronic illness. And all of this for just one phase of a much bigger project: extending to the entire population GP care without fees.
So I concluded we should try to introduce it in a different way – a way that ensured it happened more smoothly and efficiently. I explained the situation to the Cabinet committee on health last month and it agreed I should rework the proposal and come up with a better option for phasing in free GP care.
This could involve, for example, starting with people in a certain age group, or people on incomes below a certain amount and then extending the scheme progressively.
We haven’t fixed on a model yet but we will do so in a way that helps expedite the plan, rather than one that causes further delay.
There is no “U-turn” on the plan to bring in free GP care. There is simply a change in how it will be done. And it will be done.
That's government. It is not a poisoned chalice, nor a hospital pass. It is, however, sometimes a complicated and unwieldy process. We are pressing ahead with our plan to ensure that everyone has access to the highest quality care based on medical need alone. Free access to GP care for all will contribute enormously to this.
Alex White is Minister of State at the Department of Health and Labour Party TD for Dublin South