The first thing that catches your eye when you sit down in Donal O'Shea's office is a flying-saucer-like device sitting in the middle of a conference table. "Have you seen one of these?" he asks. It is the latest technology in teleconferencing; the sleek black frisbee enables O'Shea to conduct meetings with the chief executives of his area health boards without losing time commuting through traffic-snarled Dublin.
Can he apply the same magical touch to the Eastern Regional Health Authority's (ERHA) hospital waiting lists? O'Shea is far too measured to even attempt a quick-fix solution to a problem as long-standing and complex as this. However, he does accept that radical solutions are needed. In the short term he promises that arrangements to provide planned medical procedures for public patients in the region's private hospitals will be put in place by August of this year.
The authority agreed an action plan on waiting lists on April 7th (see panel, below right). It is aimed at reducing waiting lists in the specialities of ENT, orthopaedics, opthalmology, plastic surgery and vascular surgery. An initiative offering private hospital care to public patients will provide some short-term relief, but what of medium and longterm solutions to this perennial health service conundrum? O'Shea's definition of a patient on a waiting list as "someone identified as being in need of a service, but who cannot get the service at that moment in time" is carefully structured. It immediately renders as unhelpful the traditional crisis approach to waiting list reduction. "We need to examine the waiting list problem," he says.
He advocates recruitment policies aimed at matching new nurses and consultants with specific beds and specific theatre times. What about the problem whereby non-urgent medical cases are left occupying beds needed for acute care? This will require a longer-term solution, according to O'Shea.
"There is a layer missing from our health services in the eastern region. We don't have step-down facilities in the form of a network of district hospitals such as exist in other health board areas. As a result, patients who no longer require high-tech medical intervention but who are not fit to return home continue to occupy acute hospital beds." Another long-term issue he wishes to examine is a method of separating the accident and emergency demands on acute hospitals from their elective obligations.
O'Shea is clear about his role and that of the ERHA: the patient must be central to the planning of healthcare needs, with the authority acting as advocate for the people of the region in negotiations with the Department of Health. "There has been no overall statement of the needs of care groups," he says. "We need to pull together the statistics and the care principles in order to begin to address the needs of various patient groups."
A legacy of independent Department of Health funding of certain hospitals within the old Eastern Health Board area is the influx of patients from other parts of the country to avail of secondary care within the region. In numerical terms this means that 20 per cent of all patients in ERHA acute hospitals come from outside the region. In addition, up to 40 per cent of those undergoing elective work in some specialities come from outside the authority's area.
Serving a larger population than any other Irish healthcare administrator, O'Shea has been given the task of radically overhauling health and social services for the people of counties Dublin, Kildare and Wicklow. The old Eastern Health Board had begun to creak under the strain of managing the care of 1.3 million people with a diverse set of needs.
How does one rise to the top layer of Irish healthcare administrators? O'Shea graduated in electronic engineering and worked in private industry, becoming a production manager in Irish Dunlop in his native Cork. He was offered opportunities with the company abroad, but instead used his management experience to secure a post as programme manager with the Western Health Board in 1972.
Health services in the State had just been radically restructured under the 1970 Health Act. Donal O'Shea was given the task of overseeing the development of psychiatric, geriatric and mental handicap services within the western region.
Two years later he became chief executive of the North Western Health Board. When the question arose of who would head the task force on the creation of an Eastern regional "super" health authority, Donal O'Shea seemed an obvious choice. He took up the post in October 1999.
He has an excellent track record in developing primary-care services from his time as chief executive of both the North Western and North Eastern Health Boards. He accepts that there is potential to develop GP services within the ERHA. His first move will be to create three separate GP units within the three area health boards which actually deliver services within the region. He is also keen to get GPs and consultants to engage at a health service planning level: he envisages the creation of "focus groups" of local GPs and consultants drawing up protocols and priorities to improve the interface between primary and secondary care.
The health and social service needs of refugees have recently been expanded within the ERHA. From a single site operation in Dublin's Mount Street, there are now three refugee reception centres, one for each board. The centres in Francis Street, Pembroke Road and Parnell Square West offer full medical screening facilities. "Our aim is to reach 80 per cent or more of refugees with this service," says O'Shea.
Will health screening of refugees ever be made compulsory? An emphatic "no" signals his respect for individual rights and patient choice.
O'Shea is equally emphatic when I ask if there will be a reversal of the trend towards community rather than institutional psychiatric care, as is beginning to happen in Britain. He points out that many of the difficulties across the Irish Sea arise from the separation of social services and health services under the local and health authorities respectively. In fact, O'Shea feels that our unified system, unique in Europe, should be highlighted and emphasised. It will allow for more community-based psychiatry, he says.
Will the ERHA ever implement a nurse-provided 24-hour helpline similar to the NHS Direct scheme in the UK. "I have no problem with the concept, and it is certainly something which the ERHA will consider," he says. What about 24-hour general practice co-ops along the lines of the Caredoc scheme in the SEHB? "We will be encouraging GP units to work with GPs to develop appropriate levels of 24hour care," is the considered answer. He does add that a region the size of the ERHA is unlikely to develop a single model of outof-hours primary care.
When I point out that there are still some "ghetto-like" health centres within the ERHA and ask what the authority can do to ensure a better integration and uniformity of care, O'Shea offers the following: "We plan to build a network of integrated health centres across the region in the next seven to eight years designed around the needs of the users."
He talks about the requirements of a young mother with a pram who needs to access GP and dental care as well as social services during a single visit to an integrated primary care centre . . . We have set out to put this network in place and the area chief executives and myself are determined to do this."
As I leave the authority's HQ opposite the Grand Canal, commuters are rushing home to various corners of the ERHA's bailiwick. I sit on the canal bank and contemplate their future healthcare needs. The challenge to provide for such a diverse group is an enormous one: I feel it will be met more efficiently by the establishment of this unified health authority under Donal O'Shea.
Contact Dr Houston at mhouston@irish-times.ie or leave messages at 01-6707711 ext 8511