Public sector reform needs to go well beyond HSE

There’s an old cliché that says ‘health is wealth’. It might seem trite but one of the most important services that our Government is tasked to provide us with our tax is an effective and efficient health service.

However, it has failed to do so for generations. 

There are those of a certain age who would argue that the day we took the nuns out of the health system, or perhaps the day they left, was the day the health service deteriorated.

By bringing in lay health professionals, the health service became more about cash rather than care or curing.

Indeed, there are those who also argue that diseases such as MRSA were not around when the nuns ran the hospitals, and that cleanliness was next to godliness. 

There are even those who would argue that when the nuns ran the hospitals you very rarely came out of hospital sicker than you went in.

In recent days, the political departments of this and other newspapers have carried the emerging revelations about the woman called ‘Grace’ who was placed in care — and then left there for years — even after the Health Service Executive became aware of the serious allegations about the carers involved.

This story is much more than about politics. It’s also an economic and financial issue given the billions of euro spent each year in running the monolith that is the HSE.

Without the tens of thousands of caring, hard working, conscientious, and diligent ‘coal face’ employees our health service would be in a very bad place indeed. 

They perform miracles despite the support of their managers rather than because of it.

Much of the blame for this seeming dysfunctional monster has to be placed fair and square at the foot of our politicians.

Indeed, it could be argued that everything in Ireland is tarred with the finger prints of politicians as they seek to exert influence usually for their own personal benefit. 

It was that way long before the HSE came along and without serious surgery it will stay that way for a long time to come.

In an effort to solve problems that politicians couldn’t or wouldn’t or were afraid to tackle, the Government of the day sought to find ways of solving their problems without taking responsibility. 

They also wanted to continue to be able to take benefit from the systems they created to further their own career options and allow them to wield the power and prestige usually accorded to benefactors.

The end result is the many institutions and organisations set up by Government to perform a specific purpose but which are not directly controlled by the Government because they are private, limited, or limited by guarantee companies.

However, many of these bodies are fully or primarily funded by the State out of taxpayers’ money.

Similar structures prevail in the national school system where schools are built by and remain the property of the State. Teachers are paid for by the State. 

Boards of management are effectively appointed by the State. 

The curriculum and exams are determined by the State, and the exams, rules, regulations, and terms and conditions, are those of the State. 

Yet, it still allows for the State and its senior mandarins to stand back and avoid responsibility when the ‘officers’ it appoints do something illegal on school time or on school property.

Training bodies were established by the State for the purposes of jobs training and to a large extent they have done a fine job. 

However, in setting up fully funded satellites in many communities it has established virtually unaccountable entities.

It allows for political control without any responsibility or indeed accountability. Irish Water is another example.

Do we want an effective HSE? Do we want an effective educational system where third level students have more than a basic knowledge of language and numeracy? 

Yes, of course, we do.

However, until such time as all of these organisations are established for the benefit of the clients or customers and not as play things by politicians or mandarins or for the benefit of the employees, they will never be fully effective.


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