HSE in need of thorough restructuring

There doesn’t seem to be a day that goes by that we do not see one article or another about the HSE. Unfortunately, they point to a myriad of shortcomings.

Why is nothing being done about it? Fiddling around the edges is not doing something about it.

It’s not as if problems with the HSE and the health boards before it are anything new. They have not been dealt with and they never will be until we have a government health minister who is up to the task.

Oh! Where is Maggie Thatcher when you need her?

Unfortunately, the task is tough. The appalling state of the HSE is such that it will require a minister who will do what needs to be done and that will drive a coach and four through powerful vested interests.

The short answer to why it’s not being dealt with effectively is that there is apparently no one capable of taking on the considerable vested interests that lord over this dysfunctional organisation.

We should note that there are tens of thousands of HSE employees who give their all. If they didn’t we would be in a considerably worse position.

However, these folk succeed despite a management system that is not fit for purpose. We need these people to succeed and we cannot allow a situation to persist that will result in those who are doing their best to lose heart.

The current situation is not eternally sustainable. In fact, it’s not even sustainable in the short term.

In recent days we’ve had, once again, the issue of scores of people being left on trollies in hospital waiting areas, corridors and wards.

It’s a problem that just does not seem to go away. Petty disagreements between the department and the unions over the numbers seems to be what prevails rather than accepting that it needs to be put right.

According to reports heavy fines are to be imposed from this month on low-performing hospitals that do not meet Leo Varadkar’s targets for cutting waiting lists. Is there some logic to this? It escapes me if there is.

If there are token fines they will have no effect. However, if they are meaningful then all thatwill happen is that a bad situation is made worse. Giving the extra money to a hospital somewhere else does not solve the local problem.

If the resources to do the job are adequate then it is a management failure and if that’s the case why is the manager not being dealt with?

If it’s a resourcing issue then by further reducing the budget with fines the only ones who really suffer are patients. It seems we pay a lot of managers a lot of money to manage people and they are unable to do so.

The HSE has apparently asked for €1.9bn extra in the upcoming budget, hoping that extra amount will solve all its problems.

It won’t and it knows it. By the time the vested interests have taken their cut of any increased budget there’ll be only a token left for the patients.

In any event, throwing money at something is rarely the answer.

The Irish Examiner reported last Saturday that an EU nursing study has linked long shifts to increased burnout for nurses, with 27% of the 12,000 studies reporting high emotional exhaustion, 10% high depersonalisation and 17% reporting low personal accomplishment.

Those are seriously worrying statistics given that a patient’s main interface is with nurses.

Have we not had enough inquiries into unnecessary deaths in Irish hospitals? Ensuring those dealing directly with the patient are at their best is where the focus of the HSE should be.

One can only guess who is advising the minister. To address the waiting lists, the minister has announced the opening of another 300 beds.

But if you haven’t got enough staff, or properly deployed staff, opening 300 beds is unlikely to work.

The bottom line is that the HSE is a seriously dysfunctional organisation.

If it were not we would not be in the state we are. No amount of money on its own is going to solve the problems. Like Irish Water it’s not fit for purpose.

A root-and-branch restructuring is required.

Vested interests will fight hard. Unless they are exposed we are just going to keep getting more of the same. We will continue to throw away billions.


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