Scrapping of HSE - Public needs reform not name change

As a political public relations event, yesterday’s announcement that the Health Service Executive will cease to exist in 2014 turned out to be something of a PR disaster for beleaguered Health Minister James Reilly.

What should have been an upbeat news affair backfired badly as further rifts opened in the increasingly shaky Fine Gael-Labour marriage. Political discord was visible in a yawning communications gulf between Fine Gael minister Dr Reilly and Labour’s Róisín Shortall, Minister for State with responsibility for delivering the primary care health service.

It was from media reports, and not Mr Reilly or senior civil servants, that she learned HSE chief executive Cathal Magee will step down during the transition to replace it with a director and six directorates. He informed the minister in writing of his intention last Friday, suggesting that Ms Shortall, widely regarded as an effective minister, is out in the cold.

Politically, this communications failure leaves a question mark over Dr Reilly’s team leadership in the health portfolio. Adding to his political problems, he was recently named in Stubbs Gazette over a €1.9m consortium debt involving a Tipperary nursing home deal.

Mr Magee is rated as a first-class administrator and his departure was described by Ms Shortall as a “significant blow to the health service”. She added that he will be badly missed “in this very challenging time of severe budgeted pressures”.

Yet, despite claims by Fianna Fáil leader Micheál Martin that he was a “volatile” minister and that senior personnel have left the HSE because of Mr Reilly’s behaviour, alleging that Mr Magee was ‘shoved’, the outgoing boss insisted that Mr Reilly’s actions and approach had nothing to do with his decision to step down. He also denied there were serious differences between him and the minister or the Department of Health about the way the health service is managed.

At a time when bankers are being paid outrageous bonuses, it is refreshing to learn that as well as working through the transition period, Mr Magee is waiving his entitlement to a three-year salary after working only two of the five-year contract. The country needs more people of that calibre.

With a budget overrun of nearly €300m, forecast to reach half a billion euro by the end of the year, the legislative changes could not come at a more crucial time for the HSE. In a significant development, the minister and his department will in future play a much more significant role in running the health service, a change that he envisages will improve patient care and make the system more accountable to him.

Welcome though such changes may be, they are largely superficial. A jaundiced public has heard it all before. What people want to know is whether the new system will work? Given the shambolic nature of the HSE, they have every right to pose that question.

So far politicians have displayed a lack of will to address the most fundamental problem of all — namely the dismantling of the health boards. Those organisations have become top heavy with highly paid managers, a system weighed down by layer-upon-layer of administration and bureaucracy.

Invariably, the solution to recurring financial crises has been to close wards and cut back front line medical services — the very services that patients need. Unless the health boards undergo root-and-branch reform, the present discredited and dysfunctional regime will be perpetuated under a new name.