Health reforms dogged by political opposition, says HSE chief

The health service is still dogged by a lack of political support for difficult decisions about services in smaller hospitals, HSE chief Tony O’Brien has suggested.

In a paper delivered at the MacGill summer school last week, published in the Sunday Business Post today, Mr O'Brien also says that the health service needs a "significant transition fund which lies outside the normal health budget" to build capacity in primary care to take pressure off hospitals.

This echoes the recommendations of the recent all-party healthcare committee report, chaired by Social Democrats co-leader Róisín Shortall, which said the health service needs a €3 billion fund to reform the system.

Senior HSE sources said the HSE broadly agrees with the committee’s report, though has concerns about some aspects of it, including the costs of the reform plan, and the elimination of private care form the public system.

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There are also growing concerns in the Department of Health and the Department of Public Expenditure about the cost of the proposed reforms.

In his MacGill paper, Mr O’Brien pointed to the reform of cancer care in the 2000s. “A lot of unpopular and hard decisions were made at that time,” he wrote, adding that these had led to “better healthcare and outcomes for most forms of cancer”.

“Attempts to tackle these hard decisions require a type of political courage that is not often apparent,” he said. “As the truism goes – all politics is local.”

Reconfigure services

Senior HSE sources confirmed that Mr O’Brien was referring to ongoing political opposition, including at Cabinet level, to reconfiguring services at some local hospitals. The political opposition to hospital reforms was described as significant in some cases and vocal in others.

“Currently, we have 49 acute hospitals and 28 emergency departments. That is too many, and we will need to stop providing complex acute care at some many hospitals - where it is inappropriate to do so,” Mr O’Brien said.

Health sources pointed to the opposition of the Minister for Justice Charlie Flanagan when it was proposed to remove some services from his local hospital in Portlaoise. At the time, Mr Flanagan said it was his duty to advocate for the hospital. However, Government politicians such as Mr Flanagan are often pressured by their constituency rivals to ensure there is no removal or replacement of services in local hospitals.

In his paper, Mr O’Brien instanced the example of Roscommon Hospital, where some services had been removed and replaced with other activities in the face of huge local opposition.

“Today Roscommon Hospital flourishes providing less complex procedures but considerably more outpatient services, day surgery and diagnostic services to the people of Roscommon and its environs. So the sky has not fallen in, despite the prophesies of many at the time,” he said.