Former nurse takes over as general manager at UCHG

She is far too unassuming to broadcast it, but Bridget Howley will never forget New Year's Day 1999. On that day, she becomes the first nurse to be appointed general manager of a hospital in this State.

She has already had a tough induction. During the weeks leading up to Christmas, University College Hospital Galway (UCHG) was rarely out of the news, as cutbacks sought by the Western Health Board were strenuously opposed by the unions.

While the Government insisted that health boards had to live within budgets under the new accountability legislation, the Minister of State for Health and Galway West TD, Mr Frank Fahey, pointed a finger at UCHG management. Bridget Howley declines to comment on the Minister's criticisms. She was acting general manager at the time.

She does acknowledge that the decision to seek closure of two wards, a theatre and the lay-off of 45 temporary nurses at short notice caused "great hurt". It also reduced the number of patients for elective admission.

During the protracted negotiations with the Irish Nurses' Organisation (INO) and SIPTU, "there was considerable media coverage and much adverse publicity", she notes. "It was important to maintain provision of our services, the confidence of both public and staff, and to limit any adverse effect on relationships."

Words like "confidence", "empowerment" and "co-operation" pepper her vocabulary, as the Ardrahan woman outlines how she views the challenge ahead. She has already had a positive influence on the running of UCHG. Only a handful of nurses have ever progressed to hospital management but she instituted a system whereby divisional nurse managers, rather than doctors, moved into management.

"I do believe in devolving responsibility, including financial responsibility, and I do believe in nurses and doctors working together on an equal footing." Bridget Howley began her career as a registered nurse and midwife when she left the Convent of Mercy, Gort, to train in Whiston Hospital, Liverpool. Her father was ill when she was at school and this may have influenced her career choice, she says. He died just as she finished her training.

She subsequently worked in Texas, returned to Galway, and spent some time in London, specialising in cardiac nursing. She has a BSc Social Science from South Bank University, London, and an MSc(Econ) in Management of Care from the University of Wales.

In 1990, she was appointed matron of UCHG and became acting general manager last June.

Her appointment is "timely", she says, given the recent recommendation by the Commission on Nursing that more nurses should follow this route. But it will be anything but easy. UCHG has a large catchment area in the west and north-west and has the second-highest waiting list in the Republic after the Mater in Dublin.

At a recent health board meeting, consultants expressed frustration at the length of the lists and Fine Gael TD Padraic McCormack expressed shock at a 69 per cent jump in the figures from June 1997 to September 1998. Some of the 620 people awaiting general surgery have been on the list for four years, while some of the 841 seeking eye procedures have been waiting for seven years, the meeting was told.

On the positive side, a major capital investment programme is well under way at UCHG and phase one will be completed early in the new year. It will provide 50 additional beds, three new operating theatres, X-ray rooms, an accident and emergency department and 10 overnight beds, together with refurbishment of existing wards on two floors.

Planning for the second phase is at an advanced stage, she says.

This phase will include units in intensive care, high dependency, cardiac intensive care, coronary care, and four additional operating theatres, among other improvements. Patients will no longer have to travel to Dublin for cardiac operations - a particular victory for Croi, the West of Ireland Cardiology Foundation.

In the short term, however, the new general manager has to motivate more than 2,000 staff who now view the Western Health Board with some suspicion, given the handling of the proposed cutbacks.

SIPTU's recent claim that about 450 patients who could have suffered under the planned closures received treatment on foot of the union's stance is "fair", Ms Howley says.

However, the £300,000 savings sought by the health board were not secured and the overrun will have to be carried into next year. The hospital won't be penalised, as it has been given approval to implement the Government's waiting list initiative.

"But the budgetary overspend will be our problem," she says.

As for holding on to trained staff, this is not as difficult as in other areas. "Galway is still a good place to live and a good place to work," she says. Bridget's background in nursing has helped her to maintain a constant focus on the priority of patient care. She knows her staff - porters, consultants, everybody - and won't be the least upset if she is still accidentally called matron.

She is aware that she will serve as a role model for a new generation.