He became known as our cancer tsar and has a proven track record for a fearless and radical shake-up of a health service in crisis.
rofessor Tom Keane rescued our cancer services more than a decade ago, moving care from more than 30 sites (and an increased risk of misdiagnosis) to eight specialist hospitals.
As chair of the Sláintecare Implementation Advisory Council, the hope was he would do the same on a grander scale for the HSE. But along with its executive director Laura Magahy, he has resigned in frustration.
Now it is “goodbye Tom”, but the suspicion is that for some health officials who were not able for his no-nonsense style and dynamism, it was more “good riddance Tom”.
Not for the first time, the public are wondering if all the promises of a fairer and more efficient service are in another state of drift.
Prof Keane had the crucial skillset for the job, was fiercely independent and driven. He has not publicly elaborated on why he quit, although in his resignation letter he said the “requirements for implementing this unprecedented programme for change are seriously lacking”. Two years ago, speaking at a conference in Dublin, he gave a clear insight of his thinking, saying he had learned lessons from the implementation of the cancer strategy.
“The first lesson is to distinguish strategy from implementation. Beware of the risk of endless talk. I would rather have a good plan today than a perfect plan tomorrow,” he said.
He also spoke of the need to report progress and maintain momentum. We know he and Ms Magahy wanted more progress on the dismantling of the HSE into six regional authorities, which would have their own budget and autonomy.
The reasoning for the delay has been the pandemic and the cyber attack, and clearly the massive impact of both cannot be ignored.
However, the benefit of the Sláintecare office was that it was motoring on with the planning while the wider health service tackled the pandemic.
We were led to believe that the reform agenda was running in parallel with management of the pandemic. But we have been here before with a series of excuses.
When the HSE was first set up and was beset with problems including controversies over bonuses for managers, the word was that it was just “bedding down”.
Then came the recession excuse and it was blamed for stalling real root and branch progress. In the meantime, there has been much chopping and changing –including abandoned hospital trusts, abolition of an HSE board and reinstatement of a new board, the proposed abolition of the HSE and then a decision to keep it.
The idea by former health minister James Reilly to have a form of universal health insurance system in place was eventually shelved by Leo Varadkar.
The Sláintecare plan was supposed to get rid of all that switching of policy with each new government and set down an agreed blueprint for the future.
More decision making and control would be devolved locally and hospitals would be relieved of some pressure with additional care in the community. There would be fairer access, short waiting lists and newly-hired consultants would treat only public patients.
There are many vested interests at play – political, medical and a large swathe of bureaucracy resistant to change. If there was anyone who could cut through all of that, it was Tom Keane.
The next chair will be crucial.
The tendency of the past to opt for a “think the same” replacement chairman, a trusted insider, who will not rock the boat, must be avoided.