In the end, the calculation was simple enough. Voters were terrified to trade what they had for seemingly vague promises that so much more might be achieved. They may have thought health, but they voted wealth. But at least the contest was close, and as soon as the campaign drifted away from outlying matters and on to the real issues, the strengths and weaknesses of the two alternatives came into sharp focus.

At the time of going to press, Bertie Ahern now looks like the favourite for another five years, though Enda Kenny was still clinging to the hope that Independents and the remnants of the Progressive Democrats will rally to his side. With only two PD deputies in the 30th Dáil, and having been in a position to influence key areas of public policy for so long, that seems unlikely.

The PDs will now stuggle to maintain a distinctive identity, if for no other reason than the practicalities mean it will no longer qualify for public funding. Yet, even in defeat and decimation, they could well exert an even greater influence on events than their numbers would suggest.

Regard for Harney

Mary Harney has never made any secret of her desire to finish the job she started in the health portfolio. What was interesting about the day of the count was how soon people in Fianna Fáil, particularly at grass roots level, began to talk openly and positively about precisely that possibility.

In truth, and despite the old fracture that created the PDs, Ms Harney remains highly regarded within Fianna Fáil circles, while her colleague Noel Grealish is quite popular among the party’s backbenchers. At 54, Ms Harney will also be conscious that her best chance of leaving an indelible imprint on health policy is in a Fianna Fáil-led administration.

Assuming she takes the health portfolio again, she is likely to have a fairly free hand driving the reform programme. On several occasions during the campaign, senior Fianna Fáil ministers spoke approvingly of her stance on controversial issues, like co-location, even though some canvassers tried to distance themselves from it at the doors.

Shroud waving

By 14 June, which is the day a new government is expected to be formed, the ministerial in-tray at Hawkins House will be piled high. Time has been bought on the nurses dispute, but the public-only contract will now come centre stage. The Government will want to settle this quickly and avoid an unnecessary level of confrontation, but the law of unintended consequences could threaten the proposed 35-hour working week.

If the principle of a shorter working week is now being embedded for other groups, the consultants will expect to receive similar treatment. It will also be interesting to see how the representative organisations handle their situation now that some of the earlier leverage is gone. There will no doubt be plenty of shroud waving for the future of the profession, but as even more of the new positions are advertised, it will be neither possible nor practical to deny effective representation to those post-holders.

In the hospitals arena, the co-location policy will be firmly on the agenda for quick conclusion, as will the Hanly report, which is still the only show in town in terms of meeting the European Working Time Directive.

Co-location

On present indications, the debate about the location of the new national children’s hospital is now all but over and is unlikely to gain further serious attention now that the Ministerial order has been signed.

I still believe the timescale for delivering this project is much too long, and that philanthropic support is being lost because of ridiculous inertia in the Health Service Executive (HSE). Also in the in-tray will be the future of A&E services. We saw during the election that three A&E units in the North East are scheduled for quick closure and there may be others when the current review is published.

The reviews of hospital services in the Mid-West and South-West will undoubtedly be the harbinger of doom for some facilities, and the political fallout will have to be managed carefully by the HSE.

There needs to be a middle way, which balances the need to persuade people why change is necessary, but which is flexible enough to consider other viable alternatives.

No more spin?

People are generally far more understanding when the facts are put fair and square in front of them. What they won’t put up with is spin, or any effort to say that an alternative model will be better if they haven’t been convinced that the preferred one won’t make the current situation worse.

Too often, there is a bunker mentality in the public service – a fear that, if change is discussed in a participative way, that all hell will break loose and the initiative will be lost. This need not be so, but it will take a major change in current mindsets to break with past behaviours.