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Editorial - Uncertainty and confusion serving no one

We all recall when Ireland’s public health service was managed by 11 health boards (three in Dublin) from the early 1970s until 2005. Then the government established the HSE as the central body charged with managing the day-to-day delivery of health services. At the time, it was clearly stated that responsibility for policy would remain with the Department of Health.

After last year’s general election and the formation of the new coalition government, the agreed Programme for Government stated that a completely new structure would be created for the health service. It stated that the HSE would eventually be abolished and replaced by not-for-profit trusts, working under the direction of the department and, ultimately, the Minister for Health.

This new wave of reform would occur to facilitate, with greater efficiency and effectiveness, the welcome transition to a Universal Health Insurance model for our health service – to be made available to all citizens in a little over five years.

As if the severely reduced budgets and staffing levels within the Irish public health service were not difficult enough, for the past 12 months we have had the added complication of the introduction of these new organisational structures. In recent months, the situation has been further complicated, although for positive reasons, through the work of the Special Delivery Unit (SDU) in the health department, and the appointment of two new CEOs to Limerick and Galway hospitals.

Thankfully, the SDU has prioritised the needs of patients on a 24/7 basis, in hospitals that are faced with excessive demands, inadequate bed capacity, excessive waiting times for ED treatment and for elective procedures. Similarly, the new Limerick and Galway CEOs have the potential to bring greater clarity, purpose and a sense of reality to how we manage these large acute hospital groups, in a manner that gives primacy to safe patient care within the available resources.

However, these two welcome initiatives have only served to highlight the lack of cohesion, and degree of contradiction and dysfunction that now exists between the HSE, at corporate level, and the Department of Health. This was vividly demonstrated by the recent statement from the Health Minister, covered widely in national media, that the current CEO of the HSE can apply for one of the posts in the reformed structures when the HSE is finally dismantled. This is hardly the type of public comment likely to engender harmony and collective decision-making between these two essential elements of our healthcare system.

Against this unsatisfactory background it is absolutely essential that the current uncertainty and confusion is brought to an end. The government has stated that it is going to replace the HSE with alternative structures and a restored central role for the department and the Minister. These changes must be implemented without delay, as the current ‘long goodbye’ is causing great difficulties and clouding the decision-making pathways that are vital to our public health service. The Minister may have responsibility for policy, but the HSE, under law, still holds the budget.

The decision-making authorities are already too far removed from the reality of the nurse or midwife on the frontline. This situation is impinging upon the ability of individual health facilities to respond to patient need against the background of clear lines of autonomy and responsibility.

So, Minister, complete your reforms, put in place the new structures and end the current confusion, duplication and lack of clarity. Once again I must state both patients and frontline staff deserve better.

Liam Doran
General Secretary, INMO

Editorial - Uncertainty and confusion serving no one
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