The benign, wear-the-green-jersey view of our health system is that it provides wonderful services despite limitations that could easily be resolved if more resources were made available.
That view, in the very broadest terms, is challenged on several fronts, especially by international surveys that conclude some of our health workers are amongst the best paid in the world and that as a State we spend more than the EU average on health services but achieve below-average outcomes.
Nevertheless, it is important, as a grateful correspondent on this page points out, to acknowledge that wonderful kindness and outcomes can be found in what often seems a system stretched beyond breaking point.
A less benign view, one that is unfortunately vindicated by the ongoing CervicalCheck scandal, is that our health service is a top-heavy, bureaucratic, self-sustaining club where accountability is a notion as yet untested.
A more challenging but sadly valid appraisal would conclude that the HSE’s management and communications procedures are simply dishonest and deliberately misleading.
When Health Minister Simon Harris set up the CervicalCheck steering committee over a year ago his intention was to “to provide oversight and assurance on the implementation of key decisions taken by Government in relation to CervicalCheck”.
To achieve that objective three patient representatives were included in a group dominated by HSE and Department of Health personnel.
That, on first appearances, suggests that the patient representatives — especially the two directly affected by cervical cancer — would be included in all deliberations and share in a full understanding of CervicalCheck issues.
How naive; the mandarins had other priorities, priorities that seem to put system-preservation and self-preservation well ahead of transparency — or honesty as it is commonly described.
Patient representatives were not told about the latest chapter in the scandal when as many as 800 test results were not communicated to women because of a technical issue at a US centre doing the analysis.
One patient representative has said HSE officials told her there is a “pre-meeting” ahead of the steering committee’s monthly meetings.
This clearinghouse is confined to officials which stymies the minister’s stated objective of “oversight and assurance”.
One patient representative believes that meeting, one held outside the minister’s terms of engagement, decides what to tell the patient representatives and that this “pre-meeting” is the real meeting and that any subsequent one is window dressing.
It is important to establish immediately if Mr Harris was aware of this two-tier arrangement which is in obvious conflict with the ambitions he expressed when the committee was established.
If he was not, he must explain how this arrangement came into being and whether it was initiated by HSE or department staff — or both.
In a system struggling on so many fronts this may seem unimportant but is symptomatic of the malaise eating at the service’s credibility.
Unless real accountability with real consequences for individuals becomes the cultural norm in the system we will have scandal after scandal and probably needlessly lost lives too.