Health service - How poor is HSE’s state of health?

When the state’s 11 health boards were being abolished to form the single Health Service Executive (HSE) at the beginning of 2005, Health Minister Mary Harney explained that government policy should be judged on the provision of better health services for people and better value for taxpayers’ money.

Today, in the first of a three-part investigation, the Irish Examiner evaluates the current state of the HSE after five years in operation.

The evaluation is particularly pertinent in the light of the controversy over the misdiagnoses in which a number of pregnant women in different parts of the country were advised to have the foetus removed as there was no foetal heartbeat.

Such mistakes inevitably give rise to questions about the possible over-reliance on ultrasound technology. The mistakes highlight the importance of securing a second opinion, but they also give rise to grave concerns among others who may have accepted such medical advice without seeking a second opinion.

Advances in technology mean that every mistake will and, indeed, should be highlighted. Health, which is about life and death, is of the greatest importance, with the result that it attracts enormous media attention.

Ms Harney was right to emphasise that the establishment of the HSE was to improve the quality of healthcare and provide better value for money. The jury is still out on the assessment, because the Government and the HSE need to explain and demonstrate how things have improved.

Bad news on health matters is highlighted because it frequently involves loss of life, whereas it is almost taken for granted when lives are actually saved.

The HSE has suffered from negative publicity due to internal resistance to change from vested interests within the old health boards, as well as union opposition to virtually every element of the HSE’s programme of transformation. This has been compounded by the HSE’s failure to get its own message across properly.

Accountability within the HSE is appalling. In addition to the misdiagnoses scandals, there has also been the lax attitude towards children in care. Yet nobody has been held responsible for the mistakes and the inadequate performance. Out of a workforce of 110,000 just eight people were dismissed for poor or under-performance during 2009.

There have been major changes in the area of cancer care, waiting times for treatment has been cut, and the number of consultants providing public treatment has been increased enormously, but so has the cost of securing their services. People will accept the cost, provided they believe the money is not being wasted.

Since HealthStat was introduced in 2009, only one hospital has managed to achieve “a very good performance” rating. This should provide the incentives for others not only to do better, but also be seen to do better.

There has to be greater communication between the HSE, the Department of Health, and the minister to demonstrate that the money being spent is providing the health service to which we aspire.