Health service is struggling to get out of the recovery ward

Beyond the tit for tat over who has the biggest ego, Tony O’Brien’s interview showed politicians will continue to hinder progress in the health service, says Michael Clifford

Former HSE boss Tony O’Brien has once again highlighted a problem that is going to dog whomever takes up the reins in the HSE. There is only so much that can be done to improve the heath service before politics intervenes. Until that conundrum is addressed, O’Brien’s successor will continue to operate with one hand tied behind their back.

Is Simon Harris like a “frightened little boy” as former HSE head Tony O’Brien claimed? Is Mr O’Brien, embittered at his early exit from the job, resorting to name calling?

Such banalities have informed the fallout from an extensive and explosive interview provided by O’Brien in last weekend’s Sunday Business Post.

Beyond the tit for tat over who has the biggest ego and who can spin the other dry, something far more revealing emerged from the interview.

The former head of the HSE made it plain that his role in charge had to be performed with one hand tied behind his back.

The least any head of a health service could ask for is a clear policy strategy. In a country that is going through radical demographic change, and susceptible to the vagaries of global economic conditions, continuity is necessary if the chaos is to be properly addressed.

In O’Brien’s time, there was no continuity of strategy.

There was the proposed abolition of the HSE. (Branding, minister, we gotta change the branding or the skulls will crucify us). The HSE was not abolished for the reason that nothing substantially different was proposed to replace it.

Tony O'Brien

There was the removal of the board of the HSE (change the faces, minister, the public will believe that they were the problem and you’re showing cojones in “taking them on”).

There was a concept called hospital trusts. Another made-on-the-hoof policy run up the flagpole at elections.

These strategies were not thought out. They were not evidence based. They were something dreamed up by political spinners on the basis of electoral harvests.

O’Brien said in the interview that he would have liked to have achieved more but it was difficult against a backdrop of policy U-turns. Those U-turns were performed for political and expedient reasons.

Some of the policies would have required investment, and as the country is already one of the highest spenders on health in the OECD, no minister for finance was going to shovel more in without hard evidence.

One plan that is certainly worthy of consideration, particularly as it has received all party backing, is SláinteCare. This promises universal care and particularly the end to private care in public hospitals.

Everybody thinks it’s a good idea, but the only problem is that an estimated €3bn is required in order to get it off the ground.

Thanks, but no thanks, is the response from the Department of Finance. So far, €20m has been allocated. O’Brien described this approach to the policy as “concerning” and he questioned the Government’s commitment.

Whomever takes over as head of the HSE must ask themselves a basic question — Is SláinteCare the policy to fix the health service, and if so, is it going to be funded?

So far, the answer would appear to be that it is the stated policy, kind of, as long as it can be done on the cheap. It can’t but as usual, we will only be told this further down the road, when, guess what, some genius will come up with a new policy that can be done on the cheap.

O’Brien also gave an insight into how his reach was restricted in even more basic issues. A series of expert reports into emergency medicine has stated that we need fewer emergency departments in the State in order to better serve the public as a whole.

Simon Harris at launch of SláinteCare

The consultants who operate in emergency medicine have said something similar. O’Brien, as head of the HSE, was also in favour of moving in this direction. He said that he would have closed down Navan’s ED, and that Dublin only needs three rather than seven emergency departments.

Yet no politician is willing to go there. To do so would require the novel concept of leading rather than following, of rationally addressing the fears of the public rather than pandering to the fears. As of yet, there is no sign of any senior politician willing to do so in the interests of the country.

Interestingly, O’Brien did point to Mary Harney as a health minister who achieved something of substance. That was the establishment of a cancer care strategy implemented on evidence-based best practice.

There was resistance at the time to establishing centres of excellence, as it meant that some smaller venues — Sligo in particular but there were others — would lose out.

Harney came under severe pressure. So did the man brought in from Canada to kickstart the programme, Tom Keane.

Harney knew that if she caved in, Keane would walk. So she held tough and she is entitled to kudos for doing so.

However, Harney was on her last lap in politics. Keane was an outsider, who was accustomed to doing things properly. One wonders, for example, if the current minister for health was in situ at the time, would he have held tough as Harney did? How many other senior and ambitious politicians would have?

Mary Harney

The same applies today. Who would be willing to take the political risks to fix the service, to take the hits, to back up the head of the service in order to achieve real results?

The reality is that the problems in the health service are weighed down by politics. Tony O’Brien did some good things in the job. But he was found to be ill-equipped to deal with the Cervical Check scandal.

By the rational standards that apply to high public office in developed democracies, his forced early resignation was not out of place.

But he has once again highlighted a problem that is going to dog whomever takes up the reins in the HSE.

There is only so much that can be done to improve the heath service before politics intervenes. Until that conundrum is addressed, O’Brien’s successor will continue to operate with one hand tied behind their back.


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