The Sláintecare reforms are the only game in town in terms of changing the way the health service is structured and run. The plan has the backing of all the main political parties, which reduces the prospect of reform proposals being jettisoned on the election of any new government.
That is what makes so concerning the sudden resignation of two of the key figures involved in the project – the executive director of the Sláintecare programme office, Laura Magahy, and the chairman of the Sláintecare Implementation Advisory Committee, Prof Tom Keane.
In his resignation letter to the committee Prof Keane said, somewhat cryptically, that he had come to conclude "that the requirements for implementing this unprecedented programme for change are seriously lacking". Prof Keane should elaborate, perhaps to the Oireachtas health committee, as to what exactly he is alluding.
The Government says it is more committed than ever to implementing the health reform programme. And to be fair, even given the impact of the Covid-19 pandemic, the health service has received its largest ever budget with thousands of more staff promised.
However, much more needs to be done and the public needs to know what exactly has been going on behind the scenes regarding the reform plan that led to the departures this week. Does the Sláintecare office not believe it is getting sufficient support for its proposals? Has there been something of a turf war going on between it, the Department of Health, the HSE and other health agencies?
One of the original ideas was that the Sláintecare office should have been based in the Department of the Taoiseach rather than in the Department of Health. Perhaps this should be re-visited to allow the Government's most powerful office an oversight role on the implementation of the reform plan. The Government now needs to set out where it stands and determine does it want the roles of the Sláintecare programme office and the associated advisory committee to continue. If so, it should set out clearly what its responsibilities are and what powers it has at its disposal.
The Irish Times understands that one of the key issues in the background has been the proposed introduction of new regional structures with greater autonomy of budgets – a key element of Sláintecare. Supporters of the Sláintecare plan are strongly in favour but others are less so, not necessarily on grounds of principle but on the basis that now is not the correct time for more upheaval.
Reform is never easy, much less so during a pandemic. But the sense of drift, if not outright disarray, that this week’s resignations create around one of the most important reform plans of recent times must be addressed, and fast.