Alison O'Connor: Reid is one of many who tried — and failed — to sort out the health service

Without the right money and power to implement change, it's likely that any new 'saviour' will face the same fate
Alison O'Connor: Reid is one of many who tried — and failed — to sort out the health service

Paul Reid said he took the decision to step down 'with a heavy heart'. Picture: Leah Farrell / Photocall Ireland

And another one bites the dust. Paul Reid joins the long line of people, over decades now, who were going to sort out, once and for all, our ailing health services. But didn’t.

The departing chief executive of the HSE, along with a long line of health ministers, joins the pantheon of those trumped as health service saviours. 

Given enough money and clout, this blessed appointee would hand us back something unrecognisable in health service terms — equitable and operational — if we just had some patience.

Go back to April 2019. Then taoiseach Leo Varadkar told us Reid took up his chief executive post at a critical time of change and reform in our health services. 

“For the first time in a long time, we have the resources, we have the plan, and we have the people to move forward," he said.

Paul Reid, he went on to explain, would work with the newly appointed and empowered HSE board and with the executive director of Sláintecare, Laura Magahy, as implementation of the Government’s 10-year plan to improve and reform the health service “steps up a gear”. 

Ah yes, the now departed Laura Magahy, and indeed Professor Tom Keane, chairperson of the Sláintecare Implementation Advisory Council. Both resigned in September last year, citing the slow pace of change.

A decade of failings

Let’s cast our minds back further to July 2012 when then Fine Gael health minister James Reilly announced the appointment of Tony O’Brien as HSE chief. 

The new man, the minister was satisfied to observe, “has the qualities needed to drive the essential reform required to ultimately end our two-tier health system”. 

In May 2010 we had Cathal Magee. Then health minister Mary Harney was delighted he’d agreed to take up the post.

Mr Magee, she said, brought a track record of top class management and organisational leadership to our health service. He stood down in July 2012.

Further back again in June 2005, the same Mary Harney welcomed the appointment of Professor Brendan Drumm, saying he had an outstanding reputation and would bring dynamic leadership to the HSE.

"I look forward to Professor Drumm bringing his vision and leadership to this critical role and delivering the radical reform that the Irish health system needs and which the public expect," she said.

Whoever writes the statement announcing the next HSE chief executive will have to work hard to avoid veering into déjà vu territory when heralding the latest great hope. We’re back on that familiar merry go round, on the look out for that new “saviour”.

Will they come from home or abroad, from within the ranks or outside?

How much money will they have to be paid to take up the cudgels of our seemingly hopeless-case health service?

Paul Reid’s decision, on a human level, is entirely understandable. He took it, he said, with “a heavy heart”. 

To have been a health leader during a global pandemic is an enormous strain, demanding 24/7 availability. He arrived with his reform agenda under his arm to a great level of existing dysfunction, but had to pivot pretty quickly to managing the world of Covid.

As that threat has receded somewhat he has found himself back in the land of everyday reality although it has to be said that reality is cushioned by a heap of cash, over €420,000 in 2020. 

Wanting to spend more time with your family is a very legitimate reason for stepping back from the job. We can only venture into the realms of informed speculation as to other possible associated reasons why he is stepping down.

Juggling day to day with reform 'impossible'

According to HSE sources trying to combine a massive reform agenda with all the other demands of the job is a virtual impossibility.

As well as the day-to-day role, there are the demands of the Cabinet sub committee on Covid. The Cabinet sub committee on Sláintecare. Then there are the appearance before Oireachtas committees every few weeks, and the increasingly hostile and aggressive level of questioning from some politicians. 

Of course, there is little more frustrating than the slow level of progress in our health service be it accident and emergency units— University Hospital Limerick being a prime example — or the shocking state of child mental health services or overall waiting lists.

But some of the vitriol really is simply too much and does take its toll. There were also the regular media appearances and the explaining of the latest health service failure.

Micheál Martin speaks to the media after the announcement this week that Paul Reid was to step down. The Taoiseach thanked Reid 'wholeheartedly' for his work over the years. Picture: Niall Carson/PA
Micheál Martin speaks to the media after the announcement this week that Paul Reid was to step down. The Taoiseach thanked Reid 'wholeheartedly' for his work over the years. Picture: Niall Carson/PA

It’s unlikely his decision to step down was just made last Sunday despite the developments over the proposal to replace the emergency department at Our Lady’s Hospital Navan with a 24-hour medical assessment and injury unit. 

HSE insiders say they do not believe he went because of that controversy but that “it really got to him”.

Clearly acting out of political considerations, Health Minister Stephen Donnelly requested the plan be put on hold. However, Paul Reid said on RTÉ on Sunday it would proceed.

We’ve seen this sort of situation so often in the past where there is a clear patient safety imperative to go ahead with a plan but individual politicians and political parties in government, worried about the next election, take the expedient route. 

Meanwhile, the local population, understandably, given past history, does not trust the HSE when reassurances are given that the services will be available for emergency patients elsewhere — in this instance, Our Lady of Lourdes in Drogheda.

This particular controversy has also been instructive as far as reform programme Sláintecare is concerned.

Paul Reid is supposed to be knee-deep in that transformation project right now, although most people who have been observing health for any period of time have developed a cynical view as to its chances of actually happening, or the appetite for it.

“Paul Reid’s job is to bring in major reform. On the scale of it, the reform at Navan was at the lower end and we see what has happened there. If you can’t even do that where does it leave you?” asked an exasperated HSE insider.

The relationship with the health minister has apparently been business like. But like many others involved in different facets of the health system, as well as Cabinet colleagues, it’s not felt he rated Stephen Donnelly too highly.

“Polite but not warm” is the description from one observer.

It is not unusual for officials in a government department to have a level of disdain for their incumbent minister — it is the way of things — but at present in Health, this is said to be really pointed.

Health officials also believe the changes in Navan need to go ahead urgently. This is a move that was first proposed in 2009.

The bottom line is that no matter his calibre, Paul Reid is now a lame duck leader. Everyone knows he is out the door in six months. 

It is also impossible to imagine Stephen Donnelly being kept in situ after a Cabinet reshuffle that will be prompted by Micheál Martin departing the office of the Taoiseach in December.

The next task for us all is to try not to roll our eyes when we see the Paul Reid replacement ad posted, running something along the lines of the perfect candidate being a ‘go getter, with leadership and vision and the ability to drive a major programme of reform'. Once more with feeling.

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