Our health crisis - Management of hospitals fails test

IMAGINE IF, on a Tuesday morning, the chief executive of a first class, international company — say Ryanair, Kerry Group or Apple — got a report on an external audit.

Imagine further, that the auditors found that out of 51 plants under the executive’s control not one could register a “very good” in the basic, essential mechanics of their everyday business.

Nine — more or less 20% — were rated “poor”, 35, that’s 70%, scaled the heady summit defined as “fair”.

Only seven could be described as “good”.

The chief executive’s response would be curt, immediate, precise and probably close with a statement of the obvious. It might read something like:

“The standards revealed by our recent audit are unacceptable and in no way reflect the ambitions or culture of this company.

“The audit will be repeated in six months and unless very significant progress is seen it will mean the end of our relationship.”

The only part of that message which might not be included would be the line about the possibility of ending a relationship. There would be no need, it would be taken as a given.

It would also be taken as a given that if the executive did not respond in this way it would be his head on the block, not the local manager’s.

Yet, this is precisely what has happened in our chaotic, mismanaged, top-heavy, life-threatening, dirty, self-serving, infection-ridden, unhappy, €14 billion-a-year health service.

The section of the Health Information and Quality Authority audit dealing with basic cleanliness in our public hospitals has uncovered standards in hygiene and management that are utterly unacceptable.

Speaking yesterday afternoon Health Minister Mary Harney concurred, saying that hospital management is not taking the issue seriously enough.

If this was just about crisp curtains and sparkling cutlery it might be possible to be more patient, but it is about confronting and eradicating potentially fatal infections. It is about a laxity in professional standards that has killed people with MRSA.

“There is no excuse for not meeting the highest possible standards,” said Ms Harney.

Reassuringly, she also said that “there is no reason to keep anyone in the health system who is not doing the job they are being paid to do”.

However, the minister, while recognising that progress had been made in some areas, conceded that there is little enough she can do about many of the hospital managers as she does not employ them.

One would have imagined that €14bn would have bought enough leverage to insist on professional standards and the removal of barriers or personnel hindering those ambitions.

Ms Harney also said that she still loves what must be one of the least enviable jobs in the country, and expressed the view that it would not be too long more before our health service was a world leader, envied in the way our economic achievements have been.

It would be wonderful to be as optimistic as the minister, but bitter experience — and too many deaths — has shown us the difference between the rhetoric and the reality.

It would be wonderful if the minister would put it plainly to the managers who are failing so dreadfully: “Do your job or move on...”

She would have the support of the whole country and begin to restore faith in a discredited system. As she well knows, there’s been more than enough talking.