ANALYSIS:Minister has taken a step towards change but patients are unlikely to see any difference yet
THE DECISION by Minister for Health James Reilly to get rid of the Health Service Executive board by forcing its members’ resignation was no reflection on the abilities of those individuals, he said yesterday.
But, in opposition, Reilly sharply criticised decisions the board took, not least the decision to pay the first HSE chief executive, Brendan Drumm, a €70,000 bonus in 2009 at a time when operations were being cancelled and beds were being closed to balance the books. He said the bonus payment, which was in respect of 2007, was “unjustifiable” and “outrageous”.
It came as no surprise then when before the general election Fine Gael promised to abolish the HSE and restore accountability for policy and spending on health services to the Minister for Health and the Department of Health. This promise was carried through in the programme for government and the meeting between Reilly and HSE board members, where he requested and received their resignations, was a first step to achieving this goal.
However for now the change is more one of optics than anything else, despite claims by Reilly it represents “real” change, as it will be some considerable time before the HSE as an entity will cease to exist. It will be phased out when universal health insurance is introduced but that won’t bed in until a second term in Government.
For now the departing board members, who were hand-picked by the previous minister for health Mary Harney, will be replaced by an interim board made up of HSE and department officials. Some may argue this means oversight of the running of the service will lack the expertise of outsiders such as Niamh Brennan, a professor of management at UCD who compiled the infamous report on financial management in the health service before the HSE was established.
But the key issue is whether the changes made yesterday will create a vacuum in health service management between now and when a new corporate structure to oversee the running of the health services is established next year by Reilly, after legislation abolishing the HSE board is enacted, and whether the changes will make any difference to patients in the long run.
There have been many changes to health service structures in recent years, not least the creation of the HSE, and to be fair it has clocked up some achievements including the centralisation of cancer services and a new contract for hospital consultants. But, in general, it failed to stem much of the waste still in the health service and only last week the HSE board was warned by the Health Information and Quality Authority it was time for it to face up to the fact that the HSE was not implementing its reports to ensure patients didn’t continue to be put at risk in smaller hospitals.
Now there’s to be another new dawn and restoring ministerial accountability for the running of health services has to be a good thing. Too often issues of concern were raised in the Dáil only for Harney to kick them to touch, saying these were not issues for her but for the HSE. Reilly wants greater control of the health service and to be informed quickly of developments, not like last week when he hadn’t even been shown a report commissioned by the HSE on the under-utilisation of theatres in the three Dublin children hospitals before it was leaked to the media.
But if the Minister has more information will it, as he argues, ensure services are immediately improved for patients? Not if the past is anything to go by. We have known for years that patients are languishing on trolleys and that some patients wait years for outpatient appointments, but while information is key it hasn’t solved the problems of itself.
At present the chief executive of the HSE is answerable to the board and its chairman, Frank Dolphin, is answerable to the Minister. Dolphin will stay on as chair of the interim board for now to ensure there is some continuity. We have been given no precise details by Reilly of what kind of “new corporate governance structure” will replace the HSE board next year but if change is to work, a clear road map should ideally be set out for the public in advance.
However a spokesman for Reilly said last night when the board is abolished the executive will report to the department and the Minister, just like health board chief executives did. Patients nonetheless are unlikely to notice any immediate changes as a result of the developments.