Despite being labelled a poisoned chalice, Health could yet be the making of Leo Varadkar.
Even limited success in a troublesome, high-spending portfolio would surely cap Varadkar's credentials for the top job in Fine Gael after Enda Kenny goes.
Starting a job it was clear wasn’t his first choice, he is required to look on the bright side. And there is a bright side – the worst of the financial misery, which has hit Health harder than anywhere, is over.
Many of the problems of the health service are ones of image rather than substance. Raising morale and ending the sense of drift won’t cost the earth.
He brings to the job attributes that his predecessor James Reilly seemed to lack – a phalanx of support within Fine Gael, finely tuned political nous and considerable public support.
Fundamentally, Varadkar must want to succeed as the head of the health service for the same reason he wanted to train as a doctor when he was a younger man; to help people in their hour of great need.
Unpredictable sector
He will know that the fundamental guiding principle of healthcare, “First, do no harm”, is a rule he can and must apply as a politician over the next two years.
He will know that, just as in medicine, events in health administration can take an unpredictable turn and require swift responses.
The problem is that he has two years or less in which to make a mark. That would seem to limit his scope for grand new directions of policy, particularly ones that might irk the many vested interests in health.
Closing surplus and unsafe maternity units and emergency departments make clinical sense, but it won’t happen in the run-up to an election.
On the other hand, will he want to stick with the grandiose and much-criticised big ideas that Reilly pushed forward at a snail’s pace?
He’d be better advised to focus on the basics that people care about.
Why are hundreds of people on trolleys in hospital emergency departments every night, even after massive efforts to get the figures down? Why are over 330,000 people on outpatient waiting lists, 100,000 of them there for over a year? Why do people worry about their safety when going to hospital?
But he’ll also have to balance the HSE budget at a time when cost pressures are soaring. GPs, consultants and senior managers are leading the charge for higher salaries and where they go, others will want to follow.
