HSE abolition - Minister must regain full control

FROM a political standpoint it may be a poisoned chalice, but it is vital that control of Ireland’s benighted health service be restored to Government control under the firm hand of a minister with unequivocal responsibility for how patients are served and how the huge budget of the HSE is spent.

For having the courage to grasp that nettle, Health Minister James Reilly deserves to be applauded. The die was cast when he announced his intention to ask the HSE Board to resign en masse. Seeing the writing on the wall and not waiting to be asked, the board members expressed their willingness to step down. In reality, they had little choice.

For too long, former health minister Mary Harney was rightly perceived by a jaundiced public as distancing herself from the activities of the HSE. Nobody expects a minister to run its day-to-day business. But, if by disengaging from the traditional hands-on role Ms Harney hoped to put herself beyond political criticism, it was a tactic that blew up in her face as the HSE and the last government trundled from crisis to crisis in tandem.

Whatever her motive, her diminution of ministerial engagement only succeeded in whipping up public anger towards herself and an organisation characterised by interminable queues of sick patients languishing on trolleys in hospital corridors as new wards were mothballed and others closed, plus a countrywide rash of protest campaigns to save local hospitals from the axe.

From its inception, the HSE was doomed to failure. Replacing 14 regional health boards in a classic Bertie Ahern compromise whereby nobody lost a job in 1996, it became an unwieldy and overmanaged organisation not fit for purpose. To his credit, Dr Reilly has taken an important first step towards implementing ‘reform’ of the health service promised by the Programme for Government in the General Election campaign.

Regaining control of the health service means the minister can no longer pass the buck to an organisation groaning under the weight of bureaucratic managers and administrators while nurses and doctors struggle to keep an understaffed service going.

Pending more radical surgery, an interim board consisting of HSE executives and Department of Health officials will now be put in place and while its remit is still unclear, the rooting out of costly duplication throughout the health service must be high on the agenda. From here on, the wellbeing of patients and the effectiveness of policies must be central to the collective focus of the health service.

In a not unrelated development, staggering losses of €706 million by Quinn Insurance in 2009, despite claims the business was profitable, will bring home to Dr Reilly the urgency of accelerating his plan for universal health insurance. At the end of the day, the application of a ministerial scalpel to the HSE is only the start of what promises to be a long and painful process including severe pruning of top-heavy managerial ranks.

What the long-suffering want to see are reforms that will deliver tangible results and put the welfare of patients first. There is an onus on Dr Reilly to clear the muddied waters surrounding health policy and spell out in clear and unambiguous terms what kind of service he wants to see. He owes it to the public to be clear.