HSE’s structural problems cannot be wished away

The HSE was initially set up by amalgamating the old health boards with the hope that significant cost saving could be achieved by this.

Unfortunately the reality turned out to be very different, and instead we have ended up with a top-heavy bureaucratic organisation which is overburdened with overcompensated administrative and management personnel and hugely under resourced in key areas.

The inevitable result of this resource misallocation is lengthy waiting lists for basic essential services, coupled with rocketing negligence costs, the root cause of which are often down to insufficient consultants and other key staff. This problem is exacerbated every year when many Irish medics and nurses make the perfectly logical decision to move to Canada, Australia and New Zealand rather than put up with the awful working conditions in the HSE.

Children with special needs can wait years for basic therapy services. At the end of 2020, there were 21,000 children waiting for initial occupational therapy assessments, 16,000 waiting for initial speech and language assessments, and 48,000 people waiting for physiotherapy assessments.

In Ireland an entire charitable industry has grown up around providing services that health services in other EU countries provide as a matter of course but which the HSE has consistently failed to provide. Parents of children with special needs are repeatedly forced to take legal actions against the HSE in order to secure even basic services.

The performance of Mr Reid and HSE management should be assessed not on their ability to develop glossy corporate plans but on their ability to deliver essential services along with the relative speed of vaccine rollout and intensive-care unit capacity in comparison with our neighbours.

Frontline workers, who almost without exception do their best in extremely difficult conditions, have independent oversight from regulatory bodies. In contrast, independent oversight of HSE management remains non-existent. Managerial inefficiency along with poor performance by HSE management inevitably leads to insufficient funds to adequately resource frontline services. Ultimately it is patients and frontline staff who are left to bear the consequences of serial HSE management failure. The fundamental problem with the HSE remains the complete absence of any accountability at managerial level.

As Mr Reid states the already huge sums being given by the Irish taxpayer to the HSE will now be dramatically increased. Given this it is ever more important that there is a robust system of oversight for HSE management, When a doctor or nurse makes an error (often due to inadequate resourcing or having to work long hours) they face a potential public fitness to practice hearing. In contrast HSE management failings are investigated internally (if at all). The HSE went to great expense to set up and publicise “Your Say”, a department whose only purpose seems to be to pass on complaints to sections of the HSE to investigate themselves while adding yet more administrative costs in the process.

Without rigorous independent oversight of HSE management Sláintecare represents a huge financial risk to the Irish taxpayer. Massive spending increases without a functioning system of independent oversight is a recipe for financial disaster. The children’s hospital cost over-run shows what can happen when Irish health spending is allowed to get out of control.

When HSE failings occur it is the Irish taxpayer who is invariably left to foot the financial bill while individual HSE managers are never sanctioned.

While it would be unfair to blame Paul Reid for the initial set-up or past problems, as HSE director general he has an obligation to the Irish taxpayer to now put in place a robust and independent system of oversight for HSE management. All this will do is bring HSE management into line with their colleagues on the frontline.