The HSE was designed to modernise healthcare and reduce waste; two decades on, its track record in both areas is often wanting.
It may have skipped that anniversary, but the organisation is back in the spotlight after its chief executive, Bernard Gloster, announced yesterday that he will step down next March. He has given almost a year’s notice, saying he wants to “bring certainty to the future leadership of the organisation”.
Health Minister Jennifer Carroll MacNeill paid tribute to his dedication and said she looked forward to working with him “to advance a health system that works better for all”.
The HSE has often been the scapegoat for failings in healthcare and has found its future under serious doubt. Its structure has been tinkered with, with regional health boards scrapped then reinstituted. The temptation may have been to see systemic change as a magic bullet. To do so again on the back of Mr Gloster’s departure would be a mistake.
For sure, the HSE is a complex organisation with many moving parts, but the biggest problem that needs addressing is poor productivity. What is required is not so much a new broom or a new structure but a cultural shift and a willingness to take on vested interests.
He was asking what the taxpayers were getting for their money. The answer, it appears, is ‘not enough’
Take the example of new consultant contracts that include weekend work: despite higher than expected take-up, there has not been a corresponding rise in the numbers working outside Monday to Friday.
At an HSE board meeting last May, Stephen Donnelly, Ms Carroll MacNeill’s predecessor, referred to a need “to see that the increased capacity, which has now been funded, appearing in the number of clinical sessions made available”.
In blunter terms, he was asking what the taxpayers were getting for their money. The answer, it appears, is “not enough”.
Change in the HSE will be painstaking and will not be the sole responsibility of whoever succeeds Mr Gloster. They will face a daunting in-tray. Among the priorities is addressing Ireland’s laggard status when it comes to e-health – moving patient data from pen and paper to a computerised system. They will also need to encourage managers at regional level to apply pressure to execute change. Operating theatres in the public sector, for example, close hours earlier than their private counterparts.
This leads back to the fundamental issue. The question is not whether the HSE itself is fit for purpose, but whether it has the drive and ability – and the government backing – to push through the reforms needed to better look after a growing and ageing population.
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