Still no cure after decade of the HSE

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

the rule.

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

experience abroad.

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

vested interests.

editorial