The HSE and incessant reorganisation


Sir, – Further to “Regional healthcare to return in biggest restructuring of HSE in 15 years” (News, July 15th), one of the first lessons I learned as a young consultant in the NHS, during obligatory “management training”, was to recite the mantra attributed to Gaius Petronius Arbiter, the Roman satirist: “If in doubt, reorganise”.

Such words offered humorous consolation for years afterwards to those of us struggling in the healthcare trenches (oh, how we laughed), while those at Westminster devised endless repeat prescriptions for re-organisation, to deflect mounting public and professional impatience with steady deterioration in hospital and community care.

But it is only recently that I read the next part of Gaius P Arbiter’s acidic reflections (on his army training) on the tendency to reflexively “reorganise” when confronted with any new or challenging situation.

He described this process as “a wonderful method for creating the illusion of progress, while producing confusion, inefficiency, and demoralisation”. And therein lies the rub.

In 1997, immediately after taking office, Tony Blair’s New Labour government declared that it recognised that the NHS had suffered too much structural reform, and all of us in the system breathed a sigh of relief, given the endless restructuring that tormented us in the previous decade (starting with Ken Clarke’s “back of a cigarette packet” reforms of the late 1980s).

But just four years later, the Labour government “embarked on the largest, and least debated, reorganisation of the NHS for two decades”, with resulting misery, chaos and ruinous expense.

Returning to work in Ireland in 1999, I endured the comparable consequences of incessant political tinkering, and the “redisorganisation” of the health boards and existing structures, which in my experience in three hospitals in Cork (plus two in Liverpool), profoundly damaged delivery of healthcare, both in terms of patients’ experience and the staff morale. So I offer a few words of caution to the Government, as it yet again “throw its cards into the air” and hope they land advantageously, to reverse the “merger mania” of the early Noughties.

Conventional economics simply does not apply to healthcare, and employing a management style suited to factory production (“lean”, “just in time”) has yielded the current calamitous situation, with bursting emergency departments and GP surgeries, and the righteous anger of so many bright graduates towards the public healthcare service, on both sides of the Irish Sea.

We now know that gardening and exposure to nature are deeply beneficial to our wellbeing as individuals.

I would suggest that, instead of the long-failed pseudo-commercial tack, a “horticultural” approach to the collective care of human beings would be much more successful: ie organic, biologically driven, seasonal, and sensitive.

A little (metaphorical) “sunshine, water, feed, and a few kind words” would surely do more to nurture our people and their carers than any amount of algorithms, analysis and specious managerial argot.

Conversely, uprooting “delicate shoots” every few years in the pursuit of “reorganisation” will unquestionably arrest the development of anything resembling reliable growth. – Yours, etc,




in Emergency Medicine,

Adjunct Senior Lecturer

in Public Health,

University College Cork.