Health reform - Setback a chance for reflection

The omens are not looking too good for the country’s new Health Service Executive, which is designated to take over the operation of the health service from January 1 next.

As the Cabinet considers the legislation to establish the new body, which would oversee fundamental healthcare reform, its putative chief executive has withdrawn from the specially created €400,000 a year position.

Professor Aidan Halligan’s decision not to take up the post, for personal reasons, has left the Government with a major headache.

He has decided to stay in his current job in Britain, where he will remain as deputy chief medical officer of the Department of Health.

Compounding the problems for the Government, and the transition to a new Health Service Executive, is the fact that the IMPACT trade union is balloting its 25,000 members in the health sector on whether or not it will co-operate with the proposed health reforms.

Whatever about the outcome of that vote, and though the union is continuing to negotiate with the interim executive, it has instructed its members not to co-operate with briefings on the new executive due to take place in health boards and hospitals.

Ironically, Tánaiste and Minister for Health Mary Harney is expected to get an increase of e1 billion in the Estimates to run the health service, and more than half of that is earmarked for increases in pay and pensions for the 96,000 employed by it.

At this juncture, it will take more than what she learned on her fact-finding trip to the United States and Canada to improve the beleaguered health service, although it would be a start if people could be reassured that the extra money will not be swallowed up in administration.

The more immediate dilemma for the Government is how to fill the vacuum which is now in prospect for the New Year - a health service without governance.

The Cabinet should not be panicked into steadfastly abiding by its original decision that the new executive has to be in place by January 1 next if it is not practical. That date is not written in stone.

The fact that the process of finding a new chief executive for the Health Service Executive has to be revisited is not a problem of the Government’s making.

While the health boards have been abolished in anticipation of the four new health regions operating from January, their chief executives have been asked to remain in place for about six months.

When those regions were announced last September, the chairman of the Health Service Executive’s interim board, Kevin Kelly, remarked that there would be no “big bang” in starting the new health system. It was unlikely that he was envisaging finding a chief executive practically at the eleventh hour.

The point is that the new system was always going to take a settling-in period, and common sense would suggest it will be a couple of years rather than months.

The acceptance of the position of chief executive by Prof Halligan was pivotal to the establishment of the new health service executive, given his role in the modernisation of the National Health Service in Britain.

His withdrawal is now a major setback, but the period it will take to find a replacement affords the Government more time to consider the necessary legislation for such a vital programme of reform in the health service.