ANUARY marks the tenth anniversary of the setting
up of the Health Service Executive (HSE), which officially
came into being at the start of 2005, having
been set up under the Health Act 2004 by then Minister
for Health Mary Harney with the worthy aim
of putting patients first. The practical idea behind setting it
up was to try to streamline the country’s health services and
cut back on the many layers of autonomous bureaucracy
spread across all the country’s health boards that were then
abolished to be replaced by the HSE.
There was also the more cynical, but substantiable view
that the HSE was set up to help distance ministers from the
frequent trenchant criticism of our under-resourced health
services. Indeed, health ministers have since tended to let
the highly-paid executives of the organisation try to defend
the indefensible, but to take credit themselves for the good
things achieved when it suited them.
That the HSE is currently under a stay of execution
from its proposed abolition is the worst indictment of an
organisation that has failed to effect enough necessary
improvements in its ten years of existence. The situation
with people waiting long hours – days even – in an often
undignified manner on trolleys at accident and emergency
units throughout the country has not been resolved and is a
disgrace in a so-called First World country.
In many countries, they don’t keep waiting lists and sublists
of numbers waiting to get on waiting lists, like we do
here, because waiting times are short – mostly a matter of
weeks – so it is a mystery why the HSE has failed to improve
the situation, given that its honeymoon period was at the
height of the Celtic Tiger economic boom. This was a major
opportunity lost to get those basics right and they seem to
be as far away as ever now from doing so.
Having to wait a year or more to see a consultant and then
maybe the same again to get a scan – and so on – is totally
unacceptable and borders on ludicrous as people are in a far
worse condition by the time they get to the treatment stage.
Early intervention would lead to better outcomes, not only
for the patient, whose welfare should always come first, but
for the purse strings of the health services.
There is no denying the high quality of care given by the
HSE’s frontline staff when one does eventually get into
the system and outcomes are generally good. These staff
members always seem to be working under pressure, due
to the trimming of personnel numbers during the economic
downturn and the recruitment embargo that applied up to
last year, and unfortunately the cases that go wrong from
time to time portray the service in a bad light, but it should
be remembered that these are the exception rather than
Thanks to the pioneering work of people like the late Prof
Gerry O’Sullivan of Caheragh and others, we now have a
fantastic oncology service that ensures the best possible
outcomes for cancer patients. Irish doctors are well regarded
worldwide, but having educated them – and nurses
too – it is almost impossible to hang on to them because of
the chaotic way our public health services are organised
and it seems that they can obtain better pay, conditions and
At the time the HSE was set up a decade ago, Fine Gael’s
then health spokesman, Wexford-based Rossmore native,
Dr Liam Twomey, expressed concerns about accountability.
It is only now that current Minister for Health Leo
Varadkar has grasped the nettle in this regard and the HSE
service plan for 2015 has specific criteria making various
levels of management responsible for their actions and accountable
for the outcomes.
It would seem that Minister Varadkar and HSE director
general Tony O’Brien are determined to see that targets are
met, but what will happen to management team members
who fail to achieve them through lack of competence? Will
they be tolerated without some form of sanction?
The unions of which health sector workers are members
are quite powerful, but the tail must not be allowed wag the
dog. It is really up to HSE management to lead by example
and win the respect that has eluded it heretofore or otherwise
get off the stage.
What Irish people want is timely access to necessary
healthcare across the whole country, based on medical
need, through a public system that is fit for purpose. And,
it must be based on patients’ needs rather than those of