Health system reform - Local boards may rebuild confidence

IT SEEMS that a return to bigger class sizes may not be the only instance where we may have to be prepared to walk over familiar ground.

In a move taken straight from the history books, the Health Service Executive (HSE) is expected to establish up to nine regional health authorities, so it can become more efficient.

Managers of smaller, general hospitals will be directed by local health managers, who will report to a regional manager. If this arrangement seems familiar it is because it is. The HSE replaced eight health regional boards when it was established four years ago. Larger hospitals, which offer tertiary specialist care, are likely to report to a national director rather than a regional manager.

Though it might be difficult to resist a I-told-you-so moment, it is far better that these issues be confronted rather than wasting huge energy and goodwill trying to make the impossible work. The acknowledgement, tacit or otherwise, that the HSE is an overly centralised, cumbersome, unaccountable and bureaucratic organisation is overdue, but it is nonetheless welcome. The plan to devolve day-to-day operational responsibility to regional managers is also welcome.

Even though we have had more Government U-turns in the past two weeks than we have had in decades — another on disability payments yesterday — it is unlikely that Mary Harney will acknowledge that this is another.

Irrespective of that, what is most important now is that confidence in our health system is restored. Everyone who works in it and everyone who uses it, or may have to use it, deserves nothing less.

If the principle of accountability is again recognised then that will be very welcome. There was a great deal wrong with that old system, but it had the virtue of formal, local accountability. When the HSE was established those obligations were removed but nothing was put in their place and this undermined the confidence that people could have in the system.

Unless people know that they have to answer for their action — or inaction — there can be no clarity or efficiency. There is a concern though: the new structure has great potential for buck-passing and, before it is finalised, a process for quick and easy response to valid questions must be established.

One of the really disappointing developments during the HSE’s existence was how virtually all queries to the Department of Health were deflected, citing the HSE as the relevant authority. This ignored the primacy of the department and the political process set up to serve the public. This revamp offers an appropriate opportunity to the department and the minister to address their responsibilities in this area.

The health service redundancy programme must have strings attached. Without constraints it will simply encourage the 1,000 best managers to leave. The package will need to promote redeployment to facilitate reform.

HSE chief Prof Brendan Drumm, speaking recently to doctors at the Irish Hospital Consultants’ Association, said: “The two most important criteria that the public will use to judge our success will be safety and patient experience. Then the only question is: are the public health services safer and are services revolving around my needs?”

Such a clear statement but such a complicated and difficult journey to realise it. Hopefully these proposals will make it easier.