In her first newspaper interview, Minister for Health, Mary Harney tells Dr Muiris Houston, Medical Correspondent, the lose the new Health Service Executive chief executive was a setback but not a fatal blow.
The Tánaiste's Dáil office is remarkably uncluttered. While Albert Reynolds was famously a "one-page man", Mary Harney sits down for an in-depth interview without any notes.
Her ability to retain information and to give major speeches without a prepared script has impressed representative organisations and others working in the health sector. It is an ability she first developed during school debates and was further honed during her time as auditor of one of the debating societies in Trinity College, Dublin.
Has she any regrets since publicly opting for the health portfolio in the Cabinet reshuffle at the end of September? "No, no regrets." She says it has been a lot more interesting than she thought it would be. "But it is very important for me to remain focussed and to avoid being reactive or taking on a fire brigade role," she says adding that "I am not keen to get involved in individual patient cases".
What achievements would she like to see following her time in health? "What I would regard as achievements are measurable results that are positive for patients, for example, the Accident and Emergency experience."
Based on the hospitals she has visited to date, she says some of what she has seen already (in A&E) is not acceptable.
"For example, the Mater A&E is not appropriate to the needs of 2005. The Taoiseach and I went to visit it some weeks ago. The conditions that staff are working in are unacceptable as are the facilities for patients."
She also wants the Mater hospital to have more beds that originally planned. "The idea of building a new, modern, state-of-the-art acute hospital that doesn't facilitate additional capacity does not make sense." She signalled that she was looking at sanctioning an additional 100 beds for the Dublin hospital, which is already scheduled for redevelopment.
The Tánaiste acknowledged the need for a substantial increase in the number of hospital consultants - "somewhere in the order of 700-1100 more", if patient care is to improve. And while she is sympathetic to the consultants difficulties over the failure of the Medical Defence Union (MDU) to assist doctors in cases involving historical medico-legal liabilities - "patients and doctors will not be left without cover" - she is determined not to write a blank cheque for the MDU.
"I met with the MDU two weeks before Christmas. The meeting was a good one. There could yet be a negotiated solution with the MDU. I asked the organisation in good faith to consider the requests we put before them."
But Ms Harney is determined that the consultant insurance cover issue will not slow down the pace of reform on the negotiation of a new consultant common contract.
"I am not going to wait forever. Patients will get new consultants - that will happen. We need an employment model (for consultants) that is appropriate for 2005. We need a range of options rather than the rigidity of the current regime."
Are consultants overpaid? "The best people have to be paid the best salary. The vast majority work way beyond the 33 hours required (in the contract). But we have to ensure we get the best possible outcomes."
The Tánaiste emphasises that there is a need for more flexibility in consultants work practices. "You can't have high salaries and no flexibility," she says.
What of the idea that additional consultants would be asked to serve exclusively in the public sector for three to five years after appointment? "I would not be opposed to this. But some people will want to work only in the public (system), some in private and some in both."
She makes it clear that a new consultant contract will have to be flexible to cater for different models of practice.
She is keen to explore how to develop private sector facilities on the grounds of public hospitals. Management consultants will be appointed this month to examine the issue. "There are people interested in providing hospital facilities using private capital. I want to encourage that."
Might a new consultant contract also encourage doctors to carry out their public and private practices on a single campus? The Minister said she would ask management consultants to look at all aspects of the proposal.
The Tánaiste is committed to having the independent sector - her preferred term for private medicine - adopt a greater role in the health service.
"I believe in independent sector investment in healthcare. Many patients can have treatment in the private sector as the National Treatment Purchase Fund (NTPF) has shown."
She also favours the concept of the public system purchasing services from the private sector, thereby creating an element of competition within the broader health service.
Private investors will also be encouraged to invest in primary care facilities. "I want to resolve the General Medical Services issues with the Irish Medical Organisation (IMO) and then get into this," she said, adding that if we are to relieve the pressure of patients on the hospital sector, then primary care must be developed using alternative models.
Asked about the decision by Prof Aidan Halligan not to take up the post as chief executive of the Health Service Executive (HSE), Ms Harney acknowledged it was a setback, "but not a fatal blow to the reform process". She said she was hopeful a replacement would be found by the end of March, although she admitted that someone with the necessary mix of skills for the post "would not be an easy person to find".
"What we need is someone with the capacity to motivate 120,000 people; someone with full management skills who has a vision," she says, although she emphasises the chief executive does not, in her view, have to be doctor.
Was the HSE model forced through to soon without adequate structures in place? Did she consider slowing down the process after Prof. Halligan pulled out? "No, it is too important to hold back; nothing worthwhile is ever achieved without setbacks," she says.
"The HSE is responsible for the delivery of services, they will be fully accountable for that. We won't have a confused role via a vis the Department ... we will have a clear line of distinction between who is responsible for delivery and who is responsible for policy.
"I am very anxious that the HSE has a strong accountability role to the Oireachtas," she says. It is her intention that the HSE set up a parliamentary division "so that members of the Oireachtas are responded to quickly and effectively".
Looking back on the 2001 Health Act which gave medical cards to everyone over the age of 70, and in the light of the nursing home payments issue that is related to this policy, does she think that was a good decision?
"It was a policy decision made by the whole Cabinet. It would be wrong to imply any element of blame to Micheál Martin." But she adds, "maybe at the time we all made the decision somewhat in the dark in relation to the numbers involved and the costs involved. But we are where we are".