Health board CEOs backed the HSE because they realised the old system could not work nationally

I FOUND Catherine Shanahan’s articles on the HSE extremely balanced and informative (June 10-12).

However, as the former CEO of the Eastern Regional Health Authority (ERHA), one of the agencies assumed into the HSE on its establishment on January 1, 2005, I take issue with her statement (June 11) implying the former health board CEOs were resistant to the changeover from the health board system to the HSE.

In fact, the former CEOs were fully supportive of the introduction of the HSE and participated fully in the change process from its commencement in mid-2003 to mid-2005 when we exited the service.

The Brian Dobson interviews mentioned were undertaken by some former CEOs to enable them to articulate consistently and effectively to the media and other key stakeholders – such as the staff of the health boards – details of the change management programme.

The former health board CEOs recognised that the health board system was not fit for purpose primarily as it could not facilitate an effective national approach to health service planning, delivery and measurement.

They accepted that the old system was an impediment to service rationalisation and transformation, with particular reference to the acute hospital sector and to shifting the emphasis of healthcare away from hospitals to the primary and community care sectors, respectively.

They therefore welcomed the establishment of the HSE as a single national entity as the organisational framework to progress the health service “modernisation” agenda which had effectively commenced in 2000-’01with the national health strategy and the primary care strategy, in particular, and in which each of the former CEOs played leading roles.

It is widely acknowledged that, despite the best efforts of the former CEOs and others, the change management programme from early 2004 to mid-2005 was not as effective as it could and should have been.

As a result, the HSE inherited incomplete structures and processes, such as its ability to plan, finance and deliver services on an integrated care basis.

The effect of this is that, from its establishment, the HSE has had to address several different agendas, eg, the largest public sector change management programme ever undertaken in the state; the downsizing of the workforce; the transformation of service delivery; the development of chronic disease management programmes; the development of national quality standards; renegotiating national agreements and contracts; implementing the clinical directorate model of management, as well as many others.

In addition, the HSE has had to continue to deliver health and social services within reduced annual budgets.

Against this background, it is fair to say the HSE has met this challenging agenda as effectively as it could and that it is difficult to see how it could be expected to have achieved more in the relatively short timespan of five years.

In reality, the full rewards of the agenda being pursued by the HSE cannot be realised fully for some years yet.

Michael Lyons

York Avenue

Rathmines

Dublin 6

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