Time will tell whether move will improve the care given to patients

THAT the board of the Health Service Executive is no more will come as no surprise to anyone tracking the pronouncements of Dr James Reilly both prior to his becoming Health Minister and since then.

Nor will it raise any eyebrows among those familiar with Fine Gael health policy.

The party has never been an advocate of the HSE. In its Fair Care health policy document launched in April 2009, it described the HSE as “an ill-conceived experiment”. In the same document, Fine Gael promised to make the Minister for Health, “directly responsible” for hitting key targets, if it were in power. The Fine Gael/Labour Programme for Government also set out plans to change the HSE and give the health minister and his department greater responsibility.

Fine Gael is now pursing the implementation of those promises. In doing so, it marks a fundamental change to the manner in which our health service has operated since the HSE came into being on January 1, 2005. Since then, the HSE has been responsible for the day-to-day running of the health service while the Department of Health has been responsible for policy.

Prior to that time, the role of the minister was regularly confined to firefighting. For every mini or major crisis that convulsed the health service, the minister had to be seen to take charge.

The HSE was created to put an end to this. The department spin then was that by putting someone other than the minister in charge of running the health service, she or he could concentrate on the serious job of developing health policy, an important task in itself. But most saw the split in function as little more than a cynical attempt to put clear blue water between the minister and a health service so poisonous it could effectively spell an end to the most illustrious political career.

What happened yesterday — the (offered and accepted) resignation en masse of the HSE board and the establishment in its place of an interim management team — effectively returns us to the position we were in before the HSE came into being. We will now have a health service run, albeit temporarily, by senior health managers and Department of Health officials.

It could be argued that this is essentially how it was run pre-2005 when senior managers of the various health boards ran their own patch with oversight by department chiefs.

However, in an interview with the Irish Examiner in March, after just one week in office, Dr Reilly argued that Fine Gael’s plans for changing the health service were not about returning to the old status quo.

“I don’t think it’s right to say we’re reversing things, we’re changing things. We’re not going back to local health boards by any stretch of the imagination and we’re not going into duplication of roles and managers etc, etc. The criticism has been rightly that when the HSE formed, instead of achieving the synergies that should have been achieved, and in terms of a reduced cost base, it wasn’t addressed.

“Everyone held their job and was promised they could stay in the same job so it was not going to achieve its goal at that rate and it has failed to do so consequently as we all know.”

Dr Reilly also flagged at the time his intention to re-jig the HSE board. He said Fine Gael had “given an undertaking that we would change the membership of the board”. When asked if this had anything to do with the political make up of the board — all of its members were appointed by previous Health Minister Mary Harney — Dr Reilly said he “didn’t think” it would be done on a political basis but on the basis of “what’s the best thing to do to meet the needs of the HSE and our goal to see it become a much smaller organisation”. Dr Reilly said his plan was for a new, slimmed down, agency but he did not intend to change its function entirely.

If he is serious about changing the HSE, then the minister could reasonably argue that he needed to start at the top. He has promised a new corporate structure once legislation is enacted to abolish the board permanently.

He says the move is not about optics, but a return to ministerial accountability. Whether or not it will lead to any improvement in the way care is delivered to patients, only time will tell.