Building the HSE a little bit at a time

In 1994, Rudy Giuliani was elected mayor of New York City and remained in the position for eight years. Within a few years of being appointed he was almost universally credited with the major improvements in the city’s quality of life and in the reduction in violent crime that had beset New York for generations.

He did not achieve those improvements alone.

It has been argued that he did not even come up with the idea that resulted in those improvements.

The key to his success was his recruitment of a police commissioner who believed that minor disorders and violations create a permissive atmosphere that leads to further and more serious crimes.

What Rudy Giuliani did was to take up the idea and run with it.

It’s a similar argument to the one that suggests that starting off with so-called recreational drugs such as marijuana only opens the door for trying other drugs.

Whatever about the progression of drug taking, starting off with relatively minor offences, such as crossing the street arbitrarily and a host of other minor nuisance offences, seemed to have worked for Mayor Giuliani.

One can only wonder what he would have thought about the road-crossing habits on our city streets.

There are those who would suggest that Mr Giuliani’s efforts were illusory and were replicated elsewhere without the benefit of his input but that doesn’t really matter.

What does matter is the message and that is if you have a big problem, deal with it bite by bite.

It’s all very well to have a ‘gangbusters’ theory but it’s all a little like trying to bite off more than you can chew.

There are going to be far too many balls in the air at once and there are going to be an awful lot of people ready and willing to help to engineer a failure.

It’s like the answer to the question of ‘how do you eat an elephant’? The answer is a simple: ‘You eat it bite by bite’.

Perhaps that is the problem facing anyone who tries to fix the HSE.

On the outside it’s all very simple but once you have the task you begin to realise the enormity of the task.

It’s an organisation of some 100,000 employees across the country in numerous locations.

Its annual budget runs into the billions of euro.

And it always needs more.

The HSE came about from a previous effort to solve the health sector well over a decade ago which resulted in 11 different locally controlled health boards being put together overnight.

It’s a veritable nightmare.

Almost without reservation, our health ministers over the last two decades have been intelligent people and able political operators.

Without exception, they all left the department with their proverbial tails between their legs.

Unfortunately, for the incumbent, Leo Varadkar, given his experience as a doctor and as a politician climbing the greasy pole, he is only too well aware of the proverbial mountains that had to be climbed.

His boss Enda Kenny must carry much of the responsibility of this Government’s failure to make any meaningful inroads into resolving the issues associated with the dysfunctional aspects of the HSE.

It’s not as if he did not know the problems when he committed to resolving the trolley issue way back in 2011.

However, as they say, that was then and this is now.

We cannot undo what has been done or what has not been done.

Yesterday is gone.

In the last few days, the Government reached an agreement with the nurses’ unions in an effort to resolve the trolley issue. It was reached under the threat of a strike.

It’s a fix of sorts, but it comes with a downside.

That downside is that some people are going to have their hospital visits deferred so that the number of trolleys is reduced.

It allows the Government to look like it is achieving something. Mind you, the first few days have shown only a little improvement.

However, it may also be a sign that the Government has learnt that the best way to eat an elephant is bite by bite.

The next test is to find a solution that fixes a problem and does not lengthen the queues and increase waiting times.


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