BACK at the start of 2005 when the Health Service Executive (HSE) was introduced as the cure to all our health service’s ills, under the stewardship of then Minister for Health Mary Harney, there were great expectations, but they have been continually dashed in the past 14 years.
The replacement of the 11 regional health boards that ran the country’s health service up to that point was mooted by Ms Harney’s predecessor as Health Minister, now Fianna Fáil leader Micheál Martin, who at the time was basking in the glow of the success of his introduction of the smoking ban in pubs, restaurants and other workplaces, and when it looked as if he could do no wrong. The idea was good in theory: the centralised HSE would remove all the duplicated layers of bureaucracy that existed countrywide and streamline the service.
Unfortunately, the theory did not work in practice, as it was confounded by more rather than less layers of bureaucracy and, while it delivered some improvements – cancer care being the shining beacon – the wider legacy of its endeavours until now indicate that the HSE has not proven fit for purpose given the lengthy waiting lists for consultations and treatment in the public health sector and the ever-present logjams in emergency departments which see patients – many of them frail and elderly – having to wait long periods in an undignified manner on trolleys in corridors to be seen first and then admitted to scarce hospital beds.
Previously, the trolley crisis was a winter phenomenon, but it now seems to be a year-round problem, as Irish Nurses & Midwives Organisation figures recorded that 9,939 people were on trolleys this month, which averages as 320 per day. According to Labour Party health spokesman Alan Kelly, the INMO has not recorded a day yet this year where there has been less than 250 people on trolleys: ‘We should not have to accept these kind of figures as the new normal,’ he said. ‘This is completely unacceptable.’
The thing that worries him most – and should be of concern to all of us – is that figures like these haven’t shocked or shamed the government or indeed the HSE into taking any action that has any ‘meaningful deliverables.’ Current Minister for Health Simon Harris often gives the impression of being a befuddled bystander in all of the chaos, seeming to forget that he is in overall charge of the health service and needs to urgently do something about it.
Cynics would argue that the reason the HSE was set up in the first place was to provide a buffer between the Department of Health and the public so that the HSE could take the blame for things that went wrong and the Minister could take the credit for the good stuff! However, there was a lot more of the former than the latter as the HSE became embroiled in so many serious controversies over the years, including the CervicalCheck scandal of late.
The Minister’s answer seems to be to kick the problems further down the road by re-constituting the HSE and splitting it into six regions, with Cork and Kerry ending up as one of these as the counties were in the Southern Health Board of old. The SláinteCare plan drawn up by a cross-party Oireachtas committee on health agreed to the re-organisation of the HSE in order to try to restore public confidence in the organisation, with the six new regions operating autonomously, each with its own budget and reporting to the board of the HSE.
The regions will be faced with the same problems the HSE has now in terms of recruitment and retention of medical staff. Some of the peripheral regions might find it more difficult to attract them to work in their areas.
One has to wonder if there’s a hint of desperation about the whole re-organisation? Going back to a system not dissimilar to what was thought to have been a failure in the past. What evidence is there that things will be any better now?
Are we heading for Groundhog Day again? Unfortunately, there is nothing to suggest otherwise at the moment.