Bernard Allen’s culinary poser — “How do you unscramble a scrambled egg?” — is supremely apt to the situation of yet another ham-fisted attempt to transmogrify healthcare delivery into something resembling empathic efficiency and value for money.
His apposite metaphor for the challenge of reforming the HSE and transforming all or part of it into a semi-scrambled fragmentation of six constituent parts captures the essence of the depressing conundrum at hand. Such self-same conundrum has been with us forever.
Throwing more money, another quango, and a ‘project consultant’ to essentially recreate another version of the old health-board schema surely seems a tad retro, reckless, and wasteful.
Why the HSE was set up has always been hard to fathom. Of course the previous melange needed streamlining, galvanising and modernisation, but the madcap creation of a bureaucratic behemoth was nothing short of disastrous — especially in terms of cost.
Front-line action was sacrificed to ‘bums on seats’ for a plethora of middle-management duplication at an outrageously inflated salary drain. The whole thing became something of a swamp of indecision with calamitous options taken.
It seems these days that an MBA is your only man (or woman for that matter) when it comes to major appointments.
No particular related kudos are required for the actual front-line service delivery to hand, merely a notional template of intra-organisational dynamics a la private-sector business modelling.
It’s all about the sound of MBA-speak these days, with all of us mere mortals simply perceived as little economic units caught up in the vagaries of life’s irksome healthcare frameworks.
‘Supply and demand’ and ‘cost-effectiveness’ are the clarion calls. After all, this is a purely business proposition where patients are unfortunate flies in the ointment of fiscal rectitude and middle-management remuneration packages.
So, Bernard Allen’s pithy perception says it all, although in the throes of the unscrambling ‘crusade’, we are likely to end up with a Spanish omelette: Tasty for some but mottled for most.
- Patrick J Cosgrove