Overhaul HSE, urges medical expert

An overhaul of the Health Service Executive (HSE) was called for yesterday by Dr Muiris Fitzgerald, professor of medicine in University College Dublin.

He said a high-level, multi-disciplinary leadership group needed to be established to put in place a credible manpower, work-practice planning and monitoring function within the Health Service Executive.

"Otherwise, we will continue to pour money into health service salaries without any guarantee that there is a measurable increase in the quantity or quality of patient care or services."

Dr Fitzgerald said it would be crucial to manpower planning to have a highly professional postgraduate medical education and training function, fully funded, educationally independent, but with responsive input from key stake-holding constituencies such as the HSE, the university professional schools, the Departments of Health and Education, and the informed public.

Speaking at the MacGill Summer School, he said the landmark health policy document from the Department of Health in 2001 had set out a vision and a policy direction that few among the public, the professions and the policy makers could argue with. It had mapped out a strategic direction, broad implementation plans and specific timeframes for targeted outcome, all set against a backdrop for sweeping administrative restructuring and reform. But four years on, rightly or wrongly, there was a growing sense of disillusionment that we were still, despite some advances, far from that vision.

It could be legitimately argued that massive additional investment had been made, with the health budget rising in seven years from over €3 billion to almost €10 billion. The preponderance of new funding had gone into the secondary and tertiary care system, but it had been spent on salaries, administrative, clerical and professional.

So, said Dr Fitzgerald, when commentators talked pejoratively about the health service being a "bottomless pit" that could endlessly absorb resources, there was the awkward and uncomfortable realisation that "it's public services salaries, stupid!".