Niamh Griffin: Health committee bickering won't help clear waiting lists

A tense and bitter exchange between health officials and TDs this week just adds to the frustrations of those already exasperated with the health service

There were tense exchanges when Paul Reid ( left) and Robert Watt (right) attended a Joint Committee on Health meeting to discuss the oversightof Sláintecare this week. Photo: Colin Keegan, Collins Dublin

Watching from Ireland as discussions in the British parliament become more colourful every day has been entertaining, but we got a taste this week of watching Irish officials engage in spats of their own, and it was not so much fun.

The Oireachtas health committee met on Wednesday to discuss oversight and progress in the Sláintecare reform programme, mainly hearing from Robert Watt, secretary-general at the Department of Health, and Paul Reid, CEO of the HSE. Tense exchanges ensued.

“In terms of the combative nature of my answers, that’s a trait,” said Mr Watt. "You love or hate it, nothing I can do about it really now."

“It’s not a very endearing trait,” was the response from Fine Gael Senator Martin Conway.

“Apologies for that. If you don’t like it, can’t do anything about that I’m afraid,” the official went on.

“No, we don’t” was the final comment in that round.

You could only imagine anyone on a years-long waiting list for hospital treatment in Cork or Waterford shaking their heads in despair as they watched. Access to healthcare is among the most serious problems facing the State. At last count in January, around 17% of the population, adults and children, were on lists.

Instead of a forensic examination of who is responsible for which part of the plans, and details of whether concerns aired by people who resigned in frustration from this programme last year are being addressed, we got sniping. 

Deciding on ownership of actions to tackle waiting lists was described as facing a “significant challenge” in a Sláintecare implementation update published on Tuesday. It would be useful to know why, or who is side-stepping responsibilities.

There is a point, as Boris Johnson recently tried to argue, to “the cut and thrust of parliamentary debate”, but a little more thrust and less cut might have delivered more detailed information on the pace of reform. A cynic might suggest this is precisely why some questions were answered in a less-than-conciliatory manner.

In addition, the meeting came after documents emerged showing Department of Health officials rubbishing HSE recruitment targets, with the Taoiseach having to get involved, to rubbish the rubbishing.

One row broke out over an email sent by Mr Watt to Mr Reid last September which Sinn Féin health spokesperson David Cullinane and Social Democrats health spokesperson Róisín Shortall were concerned about.

Regional Health Authorities

This focused on how the current system — hospital groups in parallel with community health organisations — will be replaced by regional health authorities (RHA).

Delays to these changes lay behind those resignations from Sláintecare, which ultimately led to the disbanding of the Sláintecare Implementation Advisory Council.

It was replaced by a new programme board, chaired by Mr Watt and Mr Reid, who now have oversight of their own projects — a situation they robustly defended during the session. Ms Shortall said regionalisation has “stalled”.

“I see there, that you, Mr Watt, are talking about expanding the remit of hospital groups to include community services,” she said, referring to the email. “A person who makes that statement just doesn’t get what Sláintecare is.” 

The debate escalated, with some present saying they were unclear whether the Department of Health or health minister continue to support regionalisation. This was heatedly disputed.

“You’re allowed ask the questions, and I’m allowed answer them,” Mr Watt told Ms Shortall. "You don’t get to ask the questions and answer them."

He later said it will be “several years” before promised elective hospitals are built in Cork, Galway, and Dublin.

The HSE boss tried to damp down the fires, saying there is an “increasing personalisation of public service roles which doesn’t do good to get the right people into the public service”. A fair point, undermined however by the history of mistreatment of whistleblowers by the health services.

Dr Ankur Sharma, the psychiatrist who spoke up about misprescribing in the South Kerry children's mental health services, has said he was sidelined after raising concerns, and ultimately resigned from the service because of how he was treated.

The whistleblower who highlighted the disgraceful way the woman known as Grace was treated under the health services was removed from her job. The list goes on.

On Wednesday, it took almost two-and-a-half hours before another official on the call could get a detailed comment in. 

So anyone who managed to stay online learned a plan for the RHAs is being worked on and this, or maybe an outline — it was not clear — will be sent to the committee by September.

“Our high-level timeline is to have a detailed implementation plan completed at the end of this year, to work through 2023, to phase in implementation, and all going well, to introduce the regional health areas from 2024 onwards,” said Muiris O’Connor, assistant secretary at the Department of Health.

Even allowing for delays caused by the pandemic, this means it might be five years after the maps were published by then-Health Minister Simon Harris in July 2019 before RHAs are introduced.

In September, Professor Geraldine McCarthy resigned as chairwoman of the South/SouthWest hospital group, citing these delays.

“Despite the excellent healthcare delivered at the frontline by committed staff, it is regrettable that much-needed reform of the health services has not been delivered,” she wrote in her resignation letter.

“This includes the establishment of regional health authorities with autonomy over decisions, budgets, and capital spend.” 

The disputed email seemed to support her fears, as read by Mr Cullinane, reading: “structural changes need to be kept to a minimum” and that “there would be no vertical reorganisation”.

The plan is for six regional areas including Cork and Kerry; Limerick, Clare and North Tipperary; and a third for Waterford, south Tipperary, Kilkenny, Carlow and Wicklow.

Budgeting and recruitment are crucial, with many families saying they lack access to a service, but it is available in a neighbouring area.

This is really what Sláintecare should boil down to: can Ireland provide localised healthcare for children and adults, with centres of excellence where appropriate, and in a timely fashion?

Behind all the bluster, unless the people on that call can deliver, those waiting lists are going nowhere fast.