Examiner on HSE abolition in 2014.

Scrapping of HSE – Public needs reform not name change

As a political public relations event, yesterday’s announcement that
the Health Service Executive will cease to exist in 2014 turned out to
be something of a PR disaster for beleaguered Health Minister James

What should have been an upbeat news affair backfired badly as further
rifts opened in the increasingly shaky Fine Gael-Labour marriage.
Political discord was visible in a yawning communications gulf between
Fine Gael minister Dr Reilly and Labour’s Róisín Shortall, Minister
for State with responsibility for delivering the primary care health

It was from media reports, and not Mr Reilly or senior civil servants,
that she learned HSE chief executive Cathal Magee will step down
during the transition to replace it with a director and six
directorates. He informed the minister in writing of his intention
last Friday, suggesting that Ms Shortall, widely regarded as an
effective minister, is out in the cold.

Politically, this communications failure leaves a question mark over
Dr Reilly’s team leadership in the health portfolio. Adding to his
political problems, he was recently named in Stubbs Gazette over a
€1.9m consortium debt involving a Tipperary nursing home deal.

Mr Magee is rated as a first-class administrator and his departure was
described by Ms Shortall as a “significant blow to the health
service”. She added that he will be badly missed “in this very
challenging time of severe budgeted pressures”.

Yet, despite claims by Fianna Fáil leader Micheál Martin that he was a
“volatile” minister and that senior personnel have left the HSE
because of Mr Reilly’s behaviour, alleging that Mr Magee was ‘shoved’,
the outgoing boss insisted that Mr Reilly’s actions and approach had
nothing to do with his decision to step down. He also denied there
were serious differences between him and the minister or the
Department of Health about the way the health service is managed.

At a time when bankers are being paid outrageous bonuses, it is
refreshing to learn that as well as working through the transition
period, Mr Magee is waiving his entitlement to a three-year salary
after working only two of the five-year contract. The country needs
more people of that calibre.

With a budget overrun of nearly €300m, forecast to reach half a
billion euro by the end of the year, the legislative changes could not
come at a more crucial time for the HSE. In a significant development,
the minister and his department will in future play a much more
significant role in running the health service, a change that he
envisages will improve patient care and make the system more
accountable to him.

Welcome though such changes may be, they are largely superficial. A
jaundiced public has heard it all before. What people want to know is
whether the new system will work? Given the shambolic nature of the
HSE, they have every right to pose that question.

So far politicians have displayed a lack of will to address the most
fundamental problem of all — namely the dismantling of the health
boards. Those organisations have become top heavy with highly paid
managers, a system weighed down by layer-upon-layer of administration
and bureaucracy.

Invariably, the solution to recurring financial crises has been to
close wards and cut back front line medical services — the very
services that patients need. Unless the health boards undergo
root-and-branch reform, the present discredited and dysfunctional
regime will be perpetuated under a new name.