It’s amazing how the rules for the real world and the political world have so little bearing on each other. Just last week the Irish Independent carried an article highlighting the halving of elective surgery operations in Irish hospitals over the past four years. If your medical practice or your company halved its numbers, there would be war. In politics, however, perception is the only important reality. It is in effect a different reality.
In the real world you would have to shut the company down or lay off numbers or do something different but not in anything within the political realm. Including the Department of Health. A political organisation run by a politician. So each Minister is in hock not just to the 120,000 ‘employees’ of the health service but also to cabinet and to the political requirements of the day/week/month/year/term (substitute as needed). Indeed one cannot blame any politician for playing this game. It’s their lifeblood and is structured to prioritise short-term political objectives within the well-described “clientalist” model, so perception really is reality. Which is why, unfortunately, things are unlikely to change in any fundamental way.