Madam, – Today I picked up a copy of the Irish Medical Hospital Directory from 1956. The Department of Health at that time had one minister, one secretary general and two assistant secretaries. Its brief was “ultimate responsibility for the availability of health care for those statutorily entitled”. It was an extraordinarily busy and complex time as the VHI was still only a dream.
By the end of 1958 just over 50,000 people had signed up for voluntary health. A single minister and a relatively small retinue of staff looked after the rest.
As I compile today’s Irish Medical Directory, half the population now has private health insurance. The Department has cleverly narrowed its remit to “improving the health of the nation through policy formulation, policy evaluation and planning at a strategic level”.
We know from the experience of our last minister for health that much of this policy work is in fact contracted out to a burgeoning private sector that specialises in mass production of reports, often by people who know nothing about the sector.
We can also see that the words “ultimate responsibility” have been neatly excised from the parlance of the department and conveniently passed to a new whipping boy, known as the HSE.
With such astonishing reductions in both workload and responsibility, is it unpatriotic to ask why the department needs the services of no fewer than five ministers, a secretary general, six assistant secretaries, further multitudes of heads, director generals and directors, 140 principals and assistant principals, 110 higher executive officers, not to mention the oodles of private secretaries and personal assistants that now work for each individual minister?
Conscious of the mental health of your readers, I have spared them numerical details on the advisers, officers, researchers, analysts, drivers, messengers and communicators of various ranks that also inhabit the lovely Hawkins House.
Corporate obesity is especially unacceptable in those who choose to lecture us about ideal shape and the advantages of being lean.
Patriotism is not unknown in our health service. We look forward to good example being shown at the very top echelons. – Yours, etc,