HSE urgently needs to get it together

Minister after minister has climbed into the hot seat at the Department of Health and walked away in defeat. 

They went in with ideas galore, their heads held high and a mission to complete. They came out in defeat with their tails between their legs.

It’s been a long time since we’ve had a fully functioning and effective health system. It was disjointed and ineffective, controlled by petty political considerations, when it was 11 Regional Health Boards. Now that it is a single entity, it has become little more than a dysfunctional monster.

Despite the tens of thousands of hard-working and conscientious doctors, nurses, paramedics and so on, the HSE, as it is currently structured, appears to be a monster that is controlled by seemingly uncaring vested interests at key levels of the organisation. Inappropriate political influence is still brought to bear, which simply worsens an already bad situation.

Such structures are not unique in Ireland to the HSE but the impacts are far more serious.

However, it’s particularly hard to understand the motivation of the HSE apparatchiks who run that monolith and who, by their actions, do not seem to want an effective, efficient and caring health service.

Last week, we were treated to the unedifying spectacle of the Minister for Health apologising for those in his charge following the Portlaoise report. It would appear that this is the limit of his authority. Inefficiencies and ineffectiveness and downright mistakes occur. People die. Very expensive reports are completed and recommendations are made on how best to avoid a similar occurrence in the future.

Unfortunately, it appears to many of us that these reports are simply to kick the can up the street so that it remains ‘business as usual’. No one gets fired. No one gets demoted. It appears the minister has no such authority. More people die because lessons have not been learned. The cycle goes on. The one thing that is clear is that those who needed to know the status of the health service were aware of the problems but it seems they ignored dealing with them. Clearly, it’s way past time for this to stop.

In an article that appeared in the press a few days ago, Dr Rhona Mahony, Master of the National Maternity Hospital, opined that “medicine, particularly obstetrics, will never be error free, but error can be reduced by well-trained, well supported staff”. She further stated that the recurring theme in the report (on Portlaoise) is a lack of governance and oversight, and a lack of resources. She continued “that we are now seeing the effect of years of neglect of maternity services”.

According to Rhona Mahony, we have the lowest number of obstetricians per head of population in the OECD. The UK has three to four times the HSE complement. An ongoing theory has been that existing consultants are reluctant to dilute the huge power and control they currently hold by adding to their number. If it’s true, it’s cynical.

Recently, the HSE advertised for consultants of various disciplines and despite salaries that are generally higher than in the UK, there was very little interest. We have to ask ourselves why this is so. Could it be that the level of litigation in Ireland, coupled with neglect and a master class of bureaucrats, means that there is a view abroad that the Irish HSE is indeed ‘Angola’? Could it just be that they do not want to be associated with the Irish HSE, irrespective of the largesse? It might not look too good on their CVs?

Let’s read the words of the minister on the Portlaoise affair again: “I am ashamed at the manner in which patients were treated, without respect, care and compassion, when they most needed it, by members of my own profession and other professions.” Surely, he hasn’t forgotten that he is the organ grinder? Standing back as if it is just a bystander emphasises the responsibility this government has for the state of the service.

This monster urgently needs major and far reaching root and branch improvements. It may well need new management. The alternative may well be more dead people, who died unnecessarily early. Next time it could be one of yours or mine.


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