Single-minded leader needs to carry out major surgery at bloated organisation


ANALYSIS:The new chief executive will have to cut jobs and layers of management in an agency with 100,000 employees, writes MUIRIS HOUSTON

THE SAGA of appointing a new chief executive of the Health Service Executive (HSE) has finally ended. Cathal Magee is the third choice for the job, behind original front-runner and stated favourite of Mary Harney – Prof Tom Keane – and behind Mike Read, an experienced Australian health administrator. Both of these candidates had the advantage of coming from outside the Irish system; Magee’s early career was in the health boards, regional precursors to the HSE.

A board member of the VHI, the new chief executive has a particularly strong background in human resources. In his time with Eircom, he was noted for adopting a low-key, conciliatory approach to the unions, while at the same time delivering a major reform package for the telecoms company.

An advertisement for the job specified that a successful candidate would need “experience of operational excellence in delivering significant and complex organisational change and performance improvements”. Magee can point to success in this, but the change process involved 7,500 employees, far less than the 100,000 or so working for the HSE.

That he is not a doctor will be seen as an advantage: doctors, no matter how able, are not trained to manage – and no matter how far up the medical administrative ladder they may have risen, it would be unusual for them to have overseen more than 500 staff. It has been an unhelpful myth that medical expertise somehow conveys an advantage in undertaking the health service chief executive’s role.

What the State needs is a single-minded individual who is determined to implement a five- year shake-up of the HSE. Jobs will have to be cut, but not at the expense of front-line services to patients. Early success in pruning its bloated higher management levels would see the new chief executive putting down a marker for the rest of his term.

Magee faces many challenges. Public confidence in the HSE is at a low ebb. Its failure to offer safe care to vulnerable children has horrified many. That it was unsure until yesterday how many children had died in its care over a 10-year period and had not identified a need for legislative change some two months into an inquiry into the matter, exposed how fundamentally inept parts of the organisation are.

Its record on patient safety is poor. The breast cancer scandals of 2008 and 2009 severely dented public faith in our cancer services, while the more recent “Tallaghtgate” saga prompted patients and health professionals to question how safe people are during the vital transfer from general practice to hospital care. And the exposure of some 58,000 unreported X-rays lying around a major teaching hospital simply frightened people.

“The two most important criteria that the public will use to judge our success will be safety and patient experience. Then the only question is: are the public health services safer and are services revolving around my needs?” These are the words of Magee’s predecessor, Prof Brendan Drumm. The new chief executive could do worse than frame them in his office.

Another area in need of urgent attention is to standardise the medical treatment available to each citizen. At present a person arriving home with a stroke in Offaly can access a range of services not available to the patient with the same needs living in Galway. Similar disparities exist in other areas and for a wide range of medical conditions, despite the fact that health boards were unified in 2005. Magee will find a willing advocate for change in Dr Barry White, the HSE’s national clinical director, who has been working to achieve a uniformity of treatment standards since he took up his post.

Under pressure to reduce savings as the public purse contracts, the new CEO must look at drug costs. New Zealand spends just half the amount per head on prescribed medication as we do. Generic substitution and the cost – benefit analysis of new drugs must be introduced in order to contain our health budget.

The HSE’s performance in its first five years has been poor. What it will achieve in the next five years is now in the hands of a new chief executive.