Jacky Jones: A lot done, more to do before we get the service we deserve

Earlier this year The Economist magazine published an article on "the Francis effect" about how Pope Francis turned around Roman Catholic Global Inc in barely a year. Business schools are now thinking of including his management style as a case study in their training for future leaders. How did he do it?

The article suggests that Pope Francis grasped and implemented three essential management principles: he refocused the organisation on its main mission (ditched the red shoes, helped the poor); repositioned the brand (less censorious about homosexuality, “who am I to judge”); and restructured (got rid of some layers, clarified roles).

Six months into the job as Minister for Health, how is Leo Varadkar doing? While he is not yet walking on water he is, knowingly or unknowingly, following the Francis principles.

He has, with director general of the HSE Tony O’Brien, refocused on the mission of the health services and started the process of reorienting service delivery away from hospitals, towards health and wellbeing, prevention and primary care. This reorientation is evident in the 2015 HSE service plan.

For the first time, system-wide priorities include the implementation of Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025. Service priorities for 2015 are, first, health and wellbeing; second, primary care; and then, acute services.

Accountability

This is a turnaround from 2014 when services were listed in the opposite order. The service plan includes, also for the first time, an accountability framework specifying levels of management responsibility and when senior managers must intervene. This will ensure everyone takes responsibility for their own actions and can no longer blame “the system” when things go wrong.

Neither HSE management nor Varadkar have yet repositioned the HSE brand in the minds of citizens who believe there is more wrong with the health services than right. In fact, Irish health services compare very favourably with services provided elsewhere in Europe.

The Euro Health Consumer Index (EHCI) is a useful tool for measuring services. It synthesises information from a wide range of databanks including health observatories, patient surveys, OECD and WHO statistics, and so on. The EHCI scores a country’s services based on six factors: patients’ rights and information; waiting times; outcomes; range and reach of services; prevention; and pharmaceuticals.

The 2013 Index ranked Ireland 14th out of 33 countries (the UK ranked 13th). Services scored 61 per cent for “patient rights and information” and are rated good for healthcare law and same-day access to a GP. Waiting times scored poorly and the vast majority of citizens do not know that since October 2013 all EU citizens can avail of treatment in another member state paid for by their home country.

Ireland scored 72 per cent for outcomes, particularly for cancer survival rates. Range and reach of services, prevention and pharmaceuticals all scored well with thumbs up for long-term care for older people and smoking prevention, and thumbs down for physical activity rates and overuse of antibiotics.

Because of treatment wait-times, “Ireland is hanging on to its 14th place by the teeth”, according to the EHCI. Irish patient organisations are “radically more pessimistic in their responses [than official waiting time statistics]. It is well known that customers/patients have long memories for less good things, but if the same pessimistic results reoccur in 2014, doubts must be raised on the validity of official statistics.”

In fact, “having waiting time statistics is a not very flattering circumstance. Countries such as Germany, where waiting times vary from two to three weeks, have never felt the urge to produce waiting time data, for the same reason that Madrid has less snow ploughs than Helsinki.”

Apart from improving waiting times, what else must Varadkar and HSE management do better in 2015? First, they need a new mission to reposition the brand of HSE Inc. The Department of Health’s mission is obsolete. The HSE does not have one and its website says the mission is coming soon. Most importantly, they must keep focused on reorienting the services towards health and wellbeing, prevention and primary care.

In 1945 Dr James Deeny wrote a paper for government on the development of a national health service that criticised the lack of mission beyond vague aspirations to improve health, and the largely curative and, often inaccessible, hospital-based services. Will Varadkar and O’Brien finally achieve what has been needed for 70 years? Here’s to a new, better future for health services.

drjackyjones@gmail.com Dr Jacky Jones is as former HSE regional manager of health promotion and a member of the Healthy Ireland council.