We need actions to speak louder than words in our ailing health system

I WAS chatting to someone the other day whose pleasure (or pain) it is to spend a lot of time on the ministerial corridor in Leinster House.

I’m not dropping names here, much as I’d like to, because I must protect the identity of my informant. He (or maybe she) and I spent a bit of time ruminating about how much longer their sojourn in that bleak place might last.

The person in question is quite committed to staying there as long as possible, and doesn’t see it as a bleak place at all.

That’s my description. The ministerial corridor isn’t actually in Leinster House — it’s part of what is now Government Buildings on Merrion Square, where the Taoiseach works. It’s joined to the main parliament building by a bridge, and separated from the Taoiseach’s office by a locked door.

And the ministerial corridor is actually two corridors — ministers on one floor and junior ministers on the floor above. They only occupy their offices when the Dáil is sitting, and use them to prepare for parliamentary business and to receive delegations. Individual offices, though large, are usually quite featureless and very few of them bear the personality of their occupants.

When the Dáil isn’t sitting, the corridors echo when you walk through them — the floors have marble tiles, in a kind of checker-board pattern — and they are definitely bleak and lonely places.

But they hum with activity when the ministers are around, starting on Tuesday around lunchtime, often lasting late into the night, and all day Wednesday. Civil servants bustle, files are sent for, visitors are ferried to and fro. Things quieten down on Thursday, because even through the Dáil is sitting the activity is much more routine and predictable. By late Thursday afternoon the corridors usually return to their sepulchral peace.

The thing that struck my informant most about the busy days, though, was the amount of firefighting that went on. You might even call it unarmed firefighting.

“You think you arrive at the Dáil ready for whatever the day might throw at you,” he (or she) said. “And then something erupts – and inevitably, the information or advice you need to deal with it is somewhere else.”

Nowhere is this more true, it seems (and I’ve checked this out with a few people) than in relation to the Department of Health. Most sitting days, I’m told, it’s not unusual to find the most senior officials of the Department of Health and the top management of the HSE huddled together in the minister’s office trying to deal with an issue that has just come up.

Usually, that involves drafting and agreeing some type of holding statement that the minister can use in the Dáil to buy some time while the officials are trying to find out what the real story is.

Since the day the HSE was established, I’m told, this has been the pattern. It has become worse in recent times, largely as a result of the financial over-runs and the service crises that flow from them, but the HSE has always been a source of crisis. And therefore of crisis management.

It’s impossible to run any organisation effectively when crisis management is the norm. When you’re dealing with one crisis, another one is always brewing away quietly in the corner. You end up staggering under the weight of them. More to the point, it’s impossible to plan for the future when you’re always running to keep up with the past. There’s a kind of miracle, in some ways, in the fact that the HSE hasn’t collapsed under its own weight. We are all too familiar with the tragedies that happen when something goes wrong in the health service and we’re all becoming too familiar with the language that’s used to describe them. System failure, for instance, is becoming almost a term of art in describing the terrible things that go wrong.

System failure, of course, has the great benefit that no one has to put up their hand and take responsibility for a disaster – if the system has failed, no individual has failed. It was system failure that was blamed for the tragedy of Savita Halappanavar, and it was system failure that accounted for the pile-up of unread X-rays and scans in Tallaght Hospital recently.

The question that arises, surely, is whether system failure leads to the necessity for constant crisis management, or is caused by it. I’ve written here before about the Department of Health, and it always seems to upset them when I do. But the thing that strikes me with most force about that department is how much they seem to be about to do — any day now. Other government departments seem to produce a pretty endless flow of information about activity and plans for the future, but the Department of Health seems to spend most of its time planning about planning.

If you look at the list of their most recent publications, for instance, you’ll discover that they’re really big on setting up frameworks. A while ago they produced a really good report on value for money in disability services. It contained a clear blueprint for executive action. But instead of acting, the department has just published an “implementation framework” on the subject.

It says (I kid you not) “the Implementation Framework will be an evolving document and will be developed and amended to reflect key issues, themes and considerations arising within the monitoring and reporting framework … The development of this Framework is the first phase of the implementation planning process. The second phase, which will result in a more detailed Implementation Plan, will follow the completion of the policy appraisal …” Reading that, you may come to the same conclusion I did. Action is necessary. Action was recommended. Action is years away.

Then there’s HI. HI, in case you didn’t know, stands for Healthy Ireland. It’s a 53-page framework — yes, a framework for a healthy Ireland — with introductions by the Taoiseach and the Minister for Health. The actual word “framework” appears 81 times in the document. There’s a framework of actions, and there’s an outcomes framework. It even asks the question (and answers it over several pages) “why is a Healthy Ireland framework needed?”.

I’m not trying to belittle the idea behind this. There’s no doubt whatever that the Department of Health needs to be motivated by a commitment to health and wellbeing, and not just by responses to illness and frailty. It’s just that when you read endless reports all couched in the lame language, they’re all, in the end, about postponing necessary action. You can read HI from start to finish, and the one phrase you won’t find is “we will do”, or “we will act”.

There was a time when the Department of Health ran things. It was responsible for standards and strategy, and it decided funding priorities. Then the HSE was set up, and now the department helps them to fight fires, and publishes stuff. The immense resource of expertise and experience that our Department of Health represents is a bystander. And our health system has suffered immeasurably as a result.