No, Minister: is there a cure for all the ills of James Reilly's department?

Róisín Shorthall's sudden resignation leaves James Reilly the last man standing in the Department of Health. How has he managed to ruffle so many feathers in just 18 months?

‘DOH” READ the sign behind James Reilly one day last week as he made yet another television appearance explaining his decision to site two primary-care centres in his constituency.

The sign outside the office of the Minister for Health was an appropriate reminder of the three-letter word Homer Simpson uses when he realises he has done something foolish.

The Department of Health has had many “Doh!” moments in recent decades; the results of successive scandals over the treatment of patients. Along the way, the enormous difficulties of managing a huge health system riven by conflicting interests have damaged or shortened the careers of many of the politicians appointed to head it.

This week, the health jinx claimed yet another political scalp, as Minister of State Róisín Shortall packed her bags at short notice after running out of road in a lengthy dispute with Reilly.

His tenure looks far from certain, not just because of the continuing fallout from the row with a Labour colleague but also because of the enormous challenges in managing a shrinking health budget. A Government that switched into reverse at the first sign of protest over the availability of cancer drugs or home-help hours, to take two recent examples of relatively small-cost savings, is faced with cutting a whopping €2 billion off spending by 2014.

“Angola” is the overused nickname coined by a former minister, Brian Cowen, to describe a department historically given to infighting at the highest levels and to civil wars between vested interests, as well as the potential for landmines that can surprise the most sure-footed of politicians.

Still, the epithet is being dragged out again now to describe Dr Reilly’s 18-month tenure at the top of the department’s home in Hawkins House, an ugly office block on Hawkins Street in Dublin. Shortall’s departure is only the latest in a long line from the health service since the deputy leader of Fine Gael assumed office with big ideas.

Since March 2011, we have seen the exit of the HSE chairman, the HSE board, the VHI chairman, the VHI chief executive, the secretary general of the department and, most significantly, the chief executive of the HSE, Cathal Magee. Under Reilly’s tenure, the holders of all the biggest State jobs in health have left, leaving the Minister as virtually the last man standing. He therefore enjoys unparalleled freedom to implement his proposals, provided he can find the money.

Reilly can be brusque and unpredictable and sometimes hot-headed, and he has been depicted as a boor in the political debate of the past week, but it would be wrong to say he is unpopular in his department. Sources say he is well liked by his officials, with whom he enjoys a more relaxed rapport than existed when Mary Harney was minister.

Shortall, by contrast, was not universally popular with her staff, according to insiders who have suffered her impatience.