Tackling the culture of mediocracy within the health service

A strong case for overhaul of the HSE

 

At his appearance before the Oireachtas Committee on the Future of Healthcare, Minister for Health Simon Harris outlined eight key priorities. Many of his goals have been outlined by previous ministers: “shift our model of care towards more comprehensive and accessible primary care” has been espoused since then minister Micheál Martin launched the primary care strategy in 2001; yet the sector has never been properly resourced to achieve this paradigm shift.

“Increase health service capacity, in the form of physical infrastructure and staffing, to address unmet need and future demographic requirements” could be interpreted as a belated acknowledgment that the system suffers from a shortage of acute hospital beds.

But it is the Minister’s comments on the structure of the public health system that will attract most attention: outlining a journey towards a more devolved delivery system, he said, “I think we should legislate for integrated delivery systems within defined geographic areas; what, for now, we might call hospital and community health organisations”. Combined with his commitment to restructure the Health Service Executive this proposal would herald a return to something resembling the old health board structure.

As long as such a restructuring includes a robust system of managerial accountability, with clear sanctions for administrators who fail to implement national standards and guidelines, then this may not be an entirely retrograde step. It would bring decision making closer to users.

However, Harris clearly stated that in his view “a national health capability which takes the place of the HSE is likely to be a slimmed down body; one more equipped to lead than to directly control and, accordingly, with less management layers between the top and the front line”. But this begs an important question: would such a body not replicate the role of the Department of Health and therefore add an unnecessary layer for bureaucrats to hide behind when critical incidents involving patient safety become an issue?

Although there was a broad welcome for the Minister’s wide-ranging contribution to the debate on the future of healthcare, doctors’ representatives challenged his contention that consultants’ private work was contributing to shortcomings in public hospitals. They pointed to some 400 vacant consultant posts.

The Committee on the Future of Healthcare has been charged with producing a 10-year plan. It is an onerous task and expectations of positive change are low. Even Harris’s continuing tenure in the Department of Health may be impacted by the Fine Gael leadership issue. But whatever plans emerge from the committee’s deliberations, it must, above all, address the culture of mediocracy that pervades much of our system.

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