From today we finally have a single national health service and, with vested interests put to one side, we can build a system accessible to everyone, writes Kevin Kelly
For the past 18 months the Health Service Executive has been engaged in the most ambitious and complex change programme in the country's history. Today, June 15th, 2005, marks a milestone with the full and final transition from the previous 11 health board structures to a single, unified national service.
This is not to suggest that the work is completed - far from it. The work done to date has of necessity focused on reorganisation. This was necessary to give us the platform from which we can move forward. The real job of reform begins now, from a structural platform and with an accomplished management team ready to carry it through.
Coming from change management programmes in the private sector, it quickly became apparent to me that this was going to be different. A revolution, desired by some as a rapid solution to the many pressing problems in the service, could overload the system. An evolutionary approach would ultimately be more durable.
The reconfiguration of the structures to improve services to date has not been an easy process. The scale of the change has inevitably brought with it uncertainty for many staff. Our initial main concern was to ensure that, while this work was under way, service was not disrupted and that the patients and clients were not exposed to risk during this time.
It is a credit to everyone working in the service that this has not happened. This undertaking differed from many change management programmes, not just because of its scale but because of its complexity.
Bearing in mind the complexity of what we have been about, it has been particularly impressive the way staff have responded to the implications of the challenges.
It is important to reflect on why we are following this path in the first place. The Government realised that the State's small population and area meant that there were synergies in health delivery which were being missed.
Some examples: Patients with the same condition received different treatment depending on where in the country they lived. This was neither equitable nor just. There were few mechanisms to share best practice developed in one health board area with others. This meant lost opportunities for continuously improving patient care.
Human and financial resources could not be assigned to areas of greatest need. This led to some inflexibility and lack of responsiveness.
The separate health boards could not amalgamate their purchasing power to secure better deals from suppliers. This was not efficient or pragmatic.
Over the past year and a half I have met thousands of frontline and administrative staff throughout the health service, and never failed to be impressed. But I could not square their commitment and enthusiasm as individuals with the obstacles and difficulties experienced throughout the health service.
It was evident that, through nobody's fault, the former structures constrained and frustrated people from contributing their maximum to the care of patients.
The objectives we set out 18 months ago were threefold: to create an environment for sustained patient care, a better working environment for staff, with increased focus on frontline delivery and improved value for money for the State.
We believe that this now-unified health structure can deliver on these values over time. We are at a point where we believe that we have created an environment where real reform can now begin, based on the actions of thousands of individuals who will deliver this change.
The intense public scrutiny of the health service is to be welcomed, and for the most part it withstands such interrogation. Where failures occur, it is right that they should be made public in a more open and transparent way and decisive action be taken to correct them.
What should not be lost sight of is the inherited quality of care that has given us a standard to build on. In travelling the country daily, one finds examples of best practice and of dedication and commitment, be they on the acute or the community side.
Our challenge is to harness and build on this best practice.
Going forward to deliver a health service with access for everyone means vested interests being put to one side in favour of benefiting all. It needs a co-operative rather than confrontational debate and a focus that will cover the positive, as well as the negative. This will require a new way of assessing the effectiveness of healthcare delivery and measuring outcomes. It means putting the patient at the heart of everything we do and say about the health service.
Of necessity to date the scale of change has been incremental rather than dramatic.
But I am confident that a foundation has now been achieved which, with the support of the Minister for Health and Government, will deliver a health service which in a fair and equitable way to meet the needs of every citizen in this country.
I am confident that the foundation that has now been achieved will deliver over time a health service which every citizen in this country is entitled to and can access and of which to feel proud.