HSE leadership: the art of the impossible

Tony O’Brien had his detractors in politics yet remained in situ because no-one could think of anyone who could do better

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The news that Tony O’Brien will be stepping down as director general of the Health Service Executive this summer comes as no surprise. Mr O’Brien is nearing the end of his second three-year contract and there was no prospect of a renewal by the Government. Indeed, the statement issued by Minister for Health Simon Harris after the HSE boss made his intentions known was almost as frosty as last week’s weather.

As with Teresa May in another context, Mr O’Brien had his detractors in political circles yet remained in the post because no-one could think of anyone who could do a better job. Over-burdened and underpaid given his responsibilities, he faced a near impossible task in taking on the job of managing the health service in 2012, not long after the years of austerity. Although the funding situation improved, political short-termism and a refusal to take hard decisions ensured his big reform ambitions would not be realised.

That said, he proved more adept at analysis than execution. He was right to bemoan the lack of an overarching vision for the health service, since rectified with the publication of the Slaintecare report. Too often, however, his energies seemed to be devoted to extracting more funding from Government. The money flowed as the economy improved, yet the performance of much of the health service continues to disappoint. It remains a mystery how such a relatively well-funded system produces such poor outcomes.

His departure leaves the Government without a convenient scapegoat. The irony is that the HSE, which was supposed to have been disbanded years ago, serves as a convenient buffer between the often appalling experiences of patients and the political class. Yet the better parts of the health service are far more dynamic than Mr Harris’s department, which is supposed to be providing an overall vision for services.

In announcing his departure, Mr O’Brien said a lot has been achieved in difficult circumstances. Unfortunately, however, the 700,000 people on hospital waiting lists and the 600 or so on trolleys each night might beg to differ.

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