The HSE is being criticised for having two headquarters as the majority of staff remain at its Dublin office despite moves to decentralise. Theresa Judge reports
The Health Service Executive (HSE) has been criticised for effectively having two headquarters as it emerged that just 46 out of 300 staff due to have been decentralised to Naas have actually moved to the Co Kildare town.
While the headquarters of the HSE is in theory in Millennium Park in Naas, HSE chief executive Prof Brendan Drumm is based in offices in Parkgate Street in Dublin, as are other senior executives.
In fact, a letter from the HSE to Fine Gael leader Enda Kenny stating the number of staff decentralised gives the address of the office of the national director of human resources as Parkgate Street. The most recent figures available for the numbers decentralised are for March.
It is two years since the plan to decentralise 300 HSE staff was announced and it was said then that it would be largely completed by the end of 2006.
In response to a query from The Irish Times, the communications office, which is also based in Parkgate Street, insists the Naas headquarters is being "fully utilised". It refers to the Parkgate Street office as "a sub-office" but fails to answer a question on the numbers employed there.
Fine Gael health spokesman Dr Liam Twomey says it is unacceptable that the HSE appears to have two headquarters. "It should not be split in two - as long as this persists there is going to be disjointed thinking and a bureaucratic mess," he said. "No one knows where the headquarters of the HSE is."
This criticism follows recent disclosures, also given in response to a parliamentary question put to Tánaiste and Minister for Health Mary Harney by Enda Kenny, that the number of senior staff earning more than €75,000 nearly doubled last year.
This led to charges that the reorganisation of the health services - with the HSE being established on January 1st, 2005 to replace the health boards - was leading to increased administrative costs rather than greater efficiencies.
The HSE statement on its headquarters did not respond to a question on the rent being paid for either building, but was headed "best use is made of HSE's existing accommodation".
It said the Parkgate Street office was an "existing health services office space which was formerly occupied by HSE shared services".
It continued: "As the chief executive officer of the HSE is required to attend a large number of meetings and important business in the capital, a sub-office in Dublin was felt necessary to facilitate this.
"Such meetings typically include those with health agencies, Government Departments, trade unions, advocacy groups, as well as appearances in the Dáil and at national conferences.
"The role of the chief executive officer also necessitates a large amount of travel around Ireland and in this regard the CEO has visited staff and facilities throughout the country."
The statement concluded: "A number of senior HSE personnel are also located in Millennium Park, Naas, and it is fully utilised. This building is fully occupied and is an existing health services facility formerly used by the south western health board."
Many different groups initially welcomed the idea of getting rid of the State's 11 health boards and replacing them with a single body responsible for the day-to-day running of the health service.
However, 18 months after the HSE was established there is widespread criticism of the progress that has been made.
In response to some of this criticism, Drumm said last week that there would be significant reductions in the numbers of people employed in administration over coming years and he also said that changes being brought about by the HSE would take five years or longer to have an effect.
He argues that the increase in numbers earning more than €75,000 is largely due to wage increases given under the last national pay deal and says there has been no increase in the number of people in the organisation.
However, the HSE is being criticised for lacking transparency and accountability. The creation of new chains of command is also said to have led to confusion about people's roles and responsibilities.
Assistant general secretary of the Irish Hospital Consultants Association Donal Duffy says that while they have taken the view that the health boards are overly politicised and overly localised, there is now very little political accountability.
He says there is also "an absence of decision making" because there are either new people in posts who are not always clear about their responsibilities or roles, or people filling posts on a temporary basis who are reluctant to make decisions.
He says that while the appointment of Drumm - eight months after the HSE was set up - has brought "some momentum", he is not overly hopeful because the service is "always going to suffer from the difficulties of a large bureaucracy".
Labour health spokeswoman Liz McManus says there are problems of accountability and transparency. It appears that parallel structures are being created, for example a €100,000-a-year "director of publicity" job has recently been advertised when there already is a large communications department.
"There is a mystery now about how the HSE is structured. The lines of authority have become blurred and confused. It is very hard to know who is in charge of what," she says.
Liam Twomey says he believes Mary Harney needs to take a more hands-on approach as there is a lack of leadership and confusion about the roles of the HSE and the Department of Health.
The department is supposed to be responsible for policy, but following the publication of the recent cancer strategy, Drumm and the HSE were given the job of producing an implementation policy for it, he says. "Prof Drumm should not be drawing up policy, this is an example of a lack of clarity and bad leadership," he says.
Prof Ray Kinsella of the graduate school of business at UCD compares the Government's decision to establish the HSE at the time it did as "deciding to wallpaper the kitchen when the sink is overflowing and flooding the room".
The basic problem is a lack of capacity in the system and, instead of addressing this, it has opted for institutional change that is now distracting staff from the most pressing problems.
"Institutional reform should not have been the priority. This is now taking an enormous amount of energy and resources.
"Staff are now bogged down in this process which is distracting them from the real issues," he says.
He says he is concerned that Irish people are becoming "desensitised to the immorality of trolley wards", but research has also shown a huge lack of public confidence in the ability of the Government or other political parties to deal with the problems in the health service, Kinsella says.
The continuing crisis in accident and emergency departments was also cited by the Irish Nurses Organisation as a reflection of the failure of the reorganisation.
Industrial relations officer Phil Ní Sheaghdha says reform should be reflected in patient care, but there has been no improvement.
"Our members tell us the situation is actually worsening - we still have people waiting on trolleys in A&E, we still have the cancellation of surgery because of a lack of staff, we still have acute beds closed because of a lack of nurses."
She says the cap on staffing levels, which predates the HSE, means the delivery of frontline care is very difficult. At the same time very large amounts of cash are being spent employing temporary agency nurses.
"A huge amount of time is then wasted orientating and mentoring these agency nurses," she says.
In one hospital, the money spent on agency nurses is equivalent to 15 whole-time nursing staff, she says.