Frustration at slow pace of change forms backdrop to Sláintecare resignations

Progress report on implementation of reforms suggests a number of crucial concerns

Leo Varadkar, Laura Magahy, Tom Keane and Simon Harris  at the announcement of Ms Magahy’s appointment as executive director of the Sláintecare programme office in July 2018. Photograph: Maxwells

Leo Varadkar, Laura Magahy, Tom Keane and Simon Harris at the announcement of Ms Magahy’s appointment as executive director of the Sláintecare programme office in July 2018. Photograph: Maxwells

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The backdrop to the sudden resignation of two key figures involved in the Sláintecare programme, Laura Magahy and Prof Tom Keane, would appear to be frustration at a slow pace of change and the level and layers of bureaucracy that had to be dealt with to implement the proposed reforms.

In a letter of resignation, Keane, the chairman of the Sláintecare Implementation Advisory Committee (SIAC), said that sadly he had “come to conclude that the requirements for implementing this unprecedented programme for change are seriously lacking”.

He has not provided any further detail and Magahy has not spoken publicly about her departure as executive director of the Sláintecare programme office.

However, a new progress report for the first six months of the year on the implementation of the reforms suggests that while the vast bulk of its goals were being achieved, there also appear to be a small number of crucial concerns for the programme.

One was implementation of radical changes to the structures of the health service originally announced by the then minister for health Simon Harris in July 2019. However, the HSE has been of the view that now is not the time for such change.

Waiting lists

Another key issue was the implementation of a major multi-level plan to tackle waiting lists, on which there are now close to one million people queuing for some form of treatment.

Progress on putting in place a new ehealth initiative was also another concern.

Under the proposed structural changes health and social care would be planned and delivered in six health regions across the country instead of the 14 hospital and community management layers in place at present. Budgets would also be allocated on the basis of population demographics and health status. In essence, there would be greater regional autonomy.

The Irish Times understands that the SIAC met and subsequently wrote to the Minister for Health, Stephen Donnelly, in the early part of the year pressing for the implementation of the regional structural reforms.

Supporters of the Sláintecare programme maintain that these reforms were fundamental in terms of clinical governance, the establishment of new patient pathways and the elimination of layers of management. The argument was, if the Government was providing €2 billion more for non-Covid care, why would it allocate these resources to unreformed structures.

Structural upheaval

However, it is understood ultimately Donnelly backed the HSE view that the time was not appropriate for structural upheaval.

Another key issue centred around the Government’s new plan for tackling waiting lists. This will involve a number of elements, including planned new hospitals for elective procedures to boost capacity. Various agencies including the Department of Health, HSE, Sláintecare office and the National Treatment Purchase Fund all were involved in the plan. But it is understood there were disagreements on governance – who would do what and report to whom.

The progress report says: “Actions to deliver the multi-annual plan have been drafted; ownership of actions and implementation oversight is still under consideration.”

On the other side of the argument there are senior figures in the health service who maintain that the Sláintecare office had been “flailing around looking for a role”. It could make proposals for change but had no operational role or powers to force through what it wanted.

One highly placed source said the structures in place meant there was inevitably going to be a clash between what the Sláintecare office believed should be done and the views of those with responsibility for operations and policy.

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