If ever we’re to cherish all children equally, the HSE must be split up

SO, isn’t it about time we faced the truth about the HSE?

It doesn’t work.

It can’t work.

It will never work.

The HSE was set up to do two main jobs. First, it was asked to run the country’s hospitals – about 50 of them altogether. Second, it was asked to supply a wide range of personal, social and family services. About one-third of its budget is spent on running the hospitals, the other two-thirds on the rest of the services it provides. So, roughly speaking, about one-third of its budget goes to meet the needs of people who are ill, and the rest of the budget is spent on providing services to people who aren’t ill at all, or whose illness will be dealt with by a visit to a GP.

And yet, how do we think and talk about the HSE? We all see it as the agency that deals with us when we’re sick. That’s because that’s how the HSE sees itself.

Virtually 100% of the emotional and intellectual energy of the senior management of the HSE, and its board, is devoted to the one-third of its budget that is spent on dealing with illness.

Part of the reason for that is because it has been dealing with crisis after crisis in areas like cancer care and accident and emergency – but a big part of the reason is because its entire leadership and orientation is based on medical qualification and expertise.

In yesterday’s Irish Examiner, for example, the lead story revealed that there are 23,000 people on waiting lists for speech and language therapy in Ireland. The vast majority of them are young people with special educational needs – and their needs are urgent – some of them will never speak properly, or at all, if they don’t get speech therapy early.

Suppose someone said to one of us that we’re never going to be able to communicate with friends and family because a relatively simple service we need right now is being withheld from us. How would we feel about that? Is there a possibility we might feel sufficiently angry to want to withhold our taxes?

And yet the waiting list for this essential therapy gets longer and longer. Do you know why? Because we simply haven’t been training enough therapists. For years there was one school of speech therapy in Ireland, producing 25 therapists a year. Now there are four courses, and the first graduates of those courses are starting to come on stream.

In 2001 a report commissioned by the Government said there was a need for a threefold increase in the number of therapists, and that’s essentially why the extra courses were established. And now, just as the graduates are starting to come on stream from those new courses, the embargo on recruitment within the HSE has ensured all those brand new therapists will have to emigrate. They have known for years that we are finally about to have a decent supply of trained therapists to begin addressing the huge backlog of need – but nobody at any level has put a plan in place. It has simply never been on the agenda.

Let’s take another example which has also been the subject of recent controversy – how the HSE delivers services to vulnerable children. These are critically important services. They’re designed to prevent damage to children in their early development, and they’re designed to protect children from harm.

As such, the HSE’s services to children are an expression of part of any government’s most sacred responsibility to its citizens. After all, no government of a civilised country would want it said it had never bothered to put decent standards of child protection in place. And where Ireland is concerned, it’s the HSE’s job to deliver on those standards.

Sounds simple enough, doesn’t it? Of course, there is always going to be the issue of how services like that are resourced and funded, and that raises a host of questions about government sincerity when it talks about the importance of children. But let’s leave that for another day. Let’s just talk about delivery of what’s there.

The standards of child protection, for example, are clear enough. They’re set out in a document called Children First that is simple to read, simple to follow and simple to implement. But they’re not implemented everywhere throughout the HSE.

Why not? Well, that’s a question people have been trying to answer for a long time. The HSE itself has never admitted there’s a problem. But it has commissioned reports into the problem all the same. So have others.

The Ombudsman for Children, Emily Logan, has examined the issue in considerable detail, and her report has been completed and is due to be published soon. I understand from within the HSE that they expect Ms Logan’s report to be devastating. The Government’s Rapporteur on Children, Geoffrey Shannon, has reported on the failure of the HSE to implement consistent standards of child protection several times. And of course there have been numerous reports into the terrible consequences for children and young people when child protection fails.

And now we have a leaked report, published last week by Alan Shatter, that sets out exactly what the problem is. The report, by a management consultancy, was commissioned because of “significant anxiety” within the HSE about how Children First is being implemented. The report was never shared with the Ombudsman for Children, who is investigating the same issue, and that’s a scandal in itself.

BUT look at what the HSE’s own privately commissioned, report says. “The current roles and responsibilities are unclear and overly complicated ... The structure needs to be leaner, more transparent, with clear lines of responsibility and accountability and line of sight from frontline services to senior management ... There is an urgent need to develop a service model for child protection that focuses on outcomes for children ... It should be based on national policy and legislation as well as wider experience ... There are critical issues in service delivery that undermine confidence in and the competence of the delivery system. These include unnecessary variation in practice, uneven collaboration between services and agencies, inadequate supports for social workers, uncoordinated interaction with the courts service and unclear responsibility for budgets and resources.”

This isn’t just management-speak. These are problems that are doing, and will do, damage to children. These issues will also do immense damage to the reputation and standing of the HSE.

The truth is that the HSE is too big, too unwieldy and too focused on the illness side of its activities ever to be able to get these things right, or even to be able to accord them enough priority. If we’re ever to get this right, we need to ensure the social services side of the HSE agenda gets at least equal priority.

I’ve argued before, and still believe, that this requires the break-up of the HSE into at least two agencies. But an interim step, open to us now, might be to replace Brendan Drumm when he retires with two people. And one of them must know something about social services.