The HSE's plans for radical reform has suddenly veered off course, writes MARTIN WALL, Industry Correspondent
SO WHERE to now for the Health Service Executive’s ambitious reform plans to streamline its administrative structures, to make its operations more efficient and, in the process, to unlock the potential for a significant voluntary redundancy scheme among managers?
The plan, which was launched last summer, aimed to replace the unwieldy “pillar” system under which hospital and community services were run separately from the bottom to the top of the organisation and in its place introduce new regional arrangements which would see all services administered locally in a number of distinct geographic areas.
At the top of the pyramid there was to be a new national director of operations who would oversee the running of regional services.
Separately, the new clinical directors in hospitals who will head up teams of senior consultants were to have a close relationship with a new national director of quality and clinical care. According to the HSE, this new director’s role was to support greater clinical involvement (ie doctors, nurses, therapists, etc) in planning and managing care services at both national and regional level.
In addition, there was also to be a new national director with responsibility for planning and performance in the HSE.
However, the reform programme’s future has been thrown into some doubt by the HSE board’s sudden decision at a meeting on Monday of last week not to proceed with these three appointments.
In a brief press statement, the HSE said its board had “reached a decision in relation to the three appointments of national director of quality and clinical care, national director of operations, and national director of planning and performance”.
“This decision will be relayed to the Public Appointments Service [PAS], who will in turn inform the candidates. Until this process is complete, it would be inappropriate to comment any further,” the statement said.
However, this terse comment masked the reality that the board had decided not to fill the three national director positions which had been the subject of an external recruitment competition. Subsequently last week, on foot of a series of questions submitted by The Irish Times, the HSE effectively sought to attribute the board’s decision to the organisation’s current financial difficulties, the Government’s new recruitment embargo and the uncertainty surrounding a long-awaited voluntary redundancy scheme.
“The board decided not to fill the three national director posts as a result of current financial pressures, the lack of clarity that exists in relation to a redundancy/early retirement scheme and the recent Government moratorium on public sector recruitment and promotion. This decision has nothing to do with the persons recommended by the interview panel,” the HSE statement said.
Undoubtedly, all of these issues played some part in the board’s decision not to fill the three posts. The HSE is facing a potential €1 billion financial deficit this year, the Government last week did introduce new curbs on employment and all has gone very quiet on plans for a joint memo to be brought to Cabinet by the Department of Health and Department of Finance on a voluntary redundancy scheme for up to 4,000 HSE staff.
But, curiously, the Government recruitment embargo was introduced after the HSE board had first considered the appointments at its regular meeting in early March. If the appointments had been ratified then, the subsequent embargo would not have had any effect.
Secondly, under the recruitment curbs set out by the Department of Finance last week, posts can be filled if the Minister for Finance agrees. However, the elephant in the room – not mentioned in the HSE statement – was the dispute between its chief executive, Prof Brendan Drumm, and the board, over who had the authority to fill one of the posts – the key national director of operations. The HSE statement did not say what impact, if any, this row had had in the decision not to make the appointments.
Last Tuesday, Prof Drumm wrote to his senior management team to inform them of the board decision. In his memo he described the three national director positions as “essential drivers in our integrated services programme”.
So if these posts were so essential to the reform programme, what will happen now that will be no appointments for the immediate future at least?
In its statement last week, the HSE said the current national hospital office and primary, community and continuing care structures would remain until a new interim arrangement on which Prof Drumm and his management team were working, was introduced.
The HSE said the board remained “fully committed to the strategic approach and key objectives in relation to the planned structural reforms” of the HSE. The HSE also said its board remained “fully committed to the regionalisation and integration policy” and that it had indicated that it wished “to accelerate both of these important initiatives without delay”.
“In this regard, the CEO and management team will identify options that will allow both policies to progress. These policies have been under way for two years and when fully implemented will greatly enhance patient access and the quality of healthcare delivery,” it said.
It said Prof Drumm would work with the management team “to identify options for regional directors reporting lines”.
So it would appear that the new regional structures are to go ahead although officially it is unclear as to how many of these there will be – possibly six – or their locations. How these regional offices will report to the centre in Dublin also remains unclear and when the new interim arrangements will be introduced is also unknown.
Last July, after The Irish Times first revealed the details of the HSE’s new structural reform plans, Minister for Health Mary Harney said they were aimed at bringing about a more effective organisational structure and better patient care.
However, she has not commented publicly on the HSE board decision while the board is not accountable publicly for its decisions.