HSE should see Hiqa as ally not foe - Overseeing our health services

OVER the weekend, HSE chief Tony O’Brien warned that there is no clear national vision for our health service and that the HSE has been starved of the funding needed to deliver reform.

He also said, during an interview with The Sunday Business Post, that budgetary timetables worked against long-term or even medium-term planning.

Minister for Health Leo Varadkar said he largely accepted Mr O’Brien’s criticisms, pointing out that he has already made many of those points himself. Such harmony, such a recognition of less than ideal delivery, between the two most powerful figures in Irish health raises pretty obvious and disheartening questions. It deepens the sense of public bewilderment — after all if they can’t fix it who can?

Mr O’Brien also argued that at least 80% of what the system does is good or very good but that 80% of coverage dealing with the HSE deals with the other 20%.

Yesterday’s relevations that Hiqa felt obliged to go to court after nine inspections of the HSE’s St Raphael’s home in Youghal, Co Cork, a large centre for people with intellectual difficulties, is an pretty clear indication of why the unsatisfactory 20% gets such coverage. Hiqa felt it necessary to use pubic funds to take this “unprecedented” step to protect the centre’s residents and ensure that basic standards were met. Why was it necessary for one State agency to pursue another in the courts to see that public policy and agreed protocols were in place?

Hiqa recorded behaviours and resource issues that have no place in a modern health service but the agency had to go to court to safeguard the centre’s clients. It is as if the HSE and Hiqa are protagonists rather than partners. Hiqa has recorded poor professional practice at St Raphael’s, as it has nationally, an indictment nurses find offensive. At the INMO conference in May, a member of the executive council described Hiqa’s standards as “paper exercises in rubbish”.

Earlier this year, in an address to the National Disability Summit, Phelim Quinn, Hiqa chief executive said: “It is disturbing and chilling to have to say that the sorts of issues we have seen ... resonate with care practices and culture that were thought to have been consigned to the past.” He described what inspectors uncovered as symptomatic of a culture so ingrained that health professionals seem “unable to distinguish between what is an acceptable and unacceptable standard of care”.

It is understandable that any effort to change a deeply- embedded culture should meet resistance but it is time health professionals and service users recognised the agency as an ally rather than a foe. It is there to try to protect the vulnerable and the system that serves them. It is a recognition that without powerful oversight chaos looms. It is a recognition that strands of our health service — €14.5bn for 4.6m people, almost half of whom have private health cover — need to change and that this may not happen unless an agency like Hiqa forces their hand. Yesterday afternoon’s apology from the HSE, and a statement outlining long overdue changes at St Raphael’s, just confirms that. Well done Hiqa.