Brian Cowen says he loves being Minister for Health. A popular perception that he did not want the brief and cannot wait to get out is myth, he declares. "That's crap, nonsense. I'm working hard. We're making decisions, getting things done. Maybe it's down to my demeanour or something. I'm very interested in the job. I love it."

It is marginally easier to believe him now. In recent weeks the health brief has been the hottest political potato since the hepatitis C controversy, with the Minister facing accusations that the health services are in a mess, hospital beds are being closed wholesale and waiting lists are ever-lengthening.

"I was glad to be in the Cabinet. I'm a traditionalist. The Taoiseach is elected, he picks his cabinet and decides who he wants. The views of my colleagues in Cabinet are as valued as mine, and all bring forward their views. Health is not run by me in isolation, same as education is not run in isolation by Micheal [Martin].

"When there is trouble I have no problem being the one to deal with that, it's my job. The idea that we are skulking and sulking around about jobs is ridiculous."

This is his first major interview since being appointed 17 months ago. It was first requested on the day before he was named Minister in June 1997, and despite regular requests since was only recently granted. His reason, he says, is that he took over a Department which was shattered following the hepatitis C controversy, a Department which needed to retire from the limelight.

It was a time, he says, to keep his head down. "I think it takes 12 months to get into a job. From a media point of view the Department was pulled and dragged all over the shop. I came in as Minister and decided that I was just not going to do that. Health needed to catch its breath. If that involves taking it off the front page, well then, that's fine."

Somewhat at odds with this was his decision to award a public relations contract worth over £100,000 to Drury's PR, which was strongly criticised in the Dail.

But, regardless of what his real level of interest is, the Minister for Health will rarely be found anything less than on top of his brief, his immense intellect coming through.

Those who deal with him say that just when they think he is paying no attention during a meeting he will lean forward with a question that cuts to the heart of the matter.

In his ardfheis speech at the weekend Mr Cowen said people continued to be bemused by the health service. The public was finding it hard to understand why every year the same problems seemed to reappear despite the fact that more and more money had been invested.

The total health budget, he said, had doubled in the past five years. For the first time this year expenditure will exceed £3 billion on day-today health service spending. Certainly, those members of the public who are on a hospital waiting list, some waiting years for a medical procedure (there are over 34,000 waiting) in a time when the economy is booming, may well find these figures bemusing.

Mr Cowen agrees that fundamental restructuring is needed and insists that he is in the process of carrying that out. However, he points out, it all takes time.

One of the main areas where he must hold firm to ensure that there can be proper investment in the future is with health board funding, he says. Controversy has surrounded the new accountability legislation, introduced to keep the boards within budget. The Western Health Board did request a meeting with him to discuss the crisis at University College Hospital in Galway. He refused. The vast majority of agencies and health boards, he says, will come in on budget at the end of the year.

"We may have a £30 million overrun throughout all the agencies, which is about 1.5 per cent, hopefully less. I'm prepared to acknowledge the effort made, it's a good effort on their part and the statutory obligations are being recognised. Some are better than others and maybe there is a residue of that culture of being `bailed out' still evident in some places. Any overruns will be a charge on next year and that will bring them their own difficulties."

This sort of budgetary discipline is the only way the service can be overhauled since it means there is money left for capital investment. "If we really are serious, if we want a modern health service and want it in a planned way, including the elimination of 19th-century health institutions, as part of the management of delivery for 21st-century health care, you have to make political choices.

"The political choice of some of my predecessors was to respond to clamour and increase revenue in an unplanned way. That may decrease the perceived problem of the day but it does not resolve the problem. If your engine is old and in need of replacement how many times do you take it to the mechanic? I want to bring people up the queue who have been so far down the queue for years because of the previous habits of acquiescing to high-profile problems.

"The hospital sector is not the only one out there. We also have mental handicap, the increasingly elderly population. How do you fund residential places if you do not have the buildings? It's not `Steady as you go' like before. I want a plan. I want machinery replaced before it dies."

The Minister is hopeful of getting £20 million in the Budget for this year's waiting-list initiative. He is defensive about not yet publishing the report of the group set up to examine the waiting-list problem, saying it is still being examined.

The notion that the £60 million spent in the past five years on the initiative has been wasted because the problem is as bad as ever is dismissed by him: "100,000 people who would not otherwise have been seen have been treated. But I've inherited the system. You can't hold back on £60 million until you change the world. You have to structure your response, and see if you have to build up capacity. You don't want to turn around and increase capacity by 300 per cent and then find it's too much. That's waste."

His real concern, he says, is the amount of time people have to spend waiting for procedures, with over 40 per cent waiting far longer than the time limits set by the Government, six months for children and a year for adults. What is needed, he says, is a "seamless system" where people who no longer need acute care in hospitals are transferred to other more suitable sites, or else with proper assistance back into the community, creating much-needed room in acute hospitals.

The estimates, he said, are that while there are 150,000 patients "inappropriately placed" in acute beds, there are a total of 90,000 temporary bed closures in the system this year. "People have to recognise what it is the system can deliver and what are the impediments. Some more resources would be a help, but these have to be planned.

"I'm not in the job to be the most popular man in Ireland. My job is to take decisions in the best long-term interest of the system regardless of whether they make me popular or not. Strategic decisions take longer but will make for a better health system. Over a four- to five-year period I think we will be able to say we have addressed many issues."