Health is wealth. And the wealth is in Dublin.

The tasks and questions facing the new Minister for Health – Jennifer McNeil Carroll – are wide and varied. They range from financial choices to moral ones. But perhaps the greatest question of all is existential – what exactly is the health service for? Who does the health service serve? What is it there for?

There are many possible answers to those questions, and as many stakeholders in health as there are people in Ireland. But still, the brief is so wide and undefined, it would be hard to know how you might measure success on a national basis.

Mostly, the Health Minister is trying to avoid stepping on landmines in ‘Angola’. For JMC, avoiding conflict with the professions and the avoidance of any major health ‘scandal’ should be enough to put her within shooting distance of Simon Harris’s leadership. That would be considered a ‘success’ politically.

But inevitably, in the Department of Health, she will encounter problems which are unacceptable in such a rich country. The first and most outlandish is that the west of the country doesn’t have the same service as the east. That’s simply unacceptable.

The number of patients on trolleys waiting for a bed is highest in our three western cities – Cork, Limerick and Galway. Effectively what this means is that there aren’t enough hospital beds in the west to cater to the population.

That’s not merely a problem for the Department of Health. There is a real need to decentralise from the Dublin magnet and spread some of the health wealth westwards. This needs to be done to put some kind of check on Dublin house prices, but also to recognise that in an era where many people can work from home, there is no need for us to put all out citizen eggs in the one Dublin basket.

But the bigger and more important reason is that if you don’t build it, people won’t come.

How can you possibly expect people to move out of Dublin when it’s obvious that they would be in a much worse situation trying to get medical help in an emergency? How can you ask doctors and nurses working in emergency care to move from a fraught professional situation in Dublin to a nightmare one in the west?

The solution being mooted is that an allowance of some sort should be paid to nurses for the extra cost involved in living in Dublin. But why stop there? If we pay nurse extra to work in Dublin, then surely teachers and members of the Gardai are also entitled to extra money?

Ten years down the line, Dublin is a different country to the rest of Ireland. Different wages, different standard of living, different health service. Like London – which has now become a haven for billionaires, but a difficult place for the average person to afford to live – Dublin would become even more distanced from the rest of the country.

The corollary is also true. If there’s a bonus for working in Dublin, then there’s a penalty for working in Cork. Or Limerick. Or Galway. Where does Dublin stop? Do you get a bonus for working in Vincent’s and living in Naas? London is a huge international city, and getting from one side to the other takes hours. Dublin is a small provincial town by comparison. If Dublin hospitals pay nurses more, we will get nurses living in Laois and Kilkenny and commuting to Dublin. Hardly progress, especially from an environmental point of view.

But the lack of equality geographically pales in comparison to the lack of equality for patient types and specific illnesses. Young people, in particular, lack access to mental health services. We still have huge numbers on waiting lists and no serious plan to reduce or eliminate them.

The obvious strategy would be to build production-line hospitals to deal with this backlog. But in Ireland, planning and bureaucracy stretches those plans far off into the distance. The stand-alone hospitals designed to reduce lists will take years to build and will cost twice as much as their international equivalents. We’re doing something wrong.

Then there’s the question of new drugs dealing with rare diseases and not so rare ones like Cystic Fibrosis. But what about the new GLP-1 medications that doctors and researchers seem to be discovering new clinical uses for almost daily? How many hospitalisations would be prevented by the government/taxpayer providing GLP-1 medication free today to patients who can’t afford it?

What is needed is urgency at government level to insist that these issues are tackled promptly – which means now, and not before the next election. And that these decisions are based on patient need, not political expediency.

Then there’s the mad world in which we live, and the fact that despite many warnings, RFK Jr. has passed his confirmation hearings and will be in charge of the health of the wealthiest nation on earth.

That’s going to crash and burn spectacularly at some stage, but in the meantime, we will see medical research cut world-wide, and actual medical facts disputed.

That matters, because with social media, American media is our media too. Irish people are vulnerable to believing Kennedy’s lies – that vaccines are poison, that COVID-19 was designed in a lab, was engineered to spare Ashkenazi Jews, and vaccine mandates were equivalent to the Holocaust – because of his family’s connections with Ireland (though his family have completely disowned him).

This is the man who will be in charge when Avian Flu becomes widespread in the US. Presumably, he thinks Avian Flu is for the birds.

He certainly is.