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30 July 2010

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Government policy and HSE mismanagement – a fatal combination

Health Minister Mary Harney – 'Modern, effective management'?

WHEN the Health Service Executive (HSE) was established in January 2005 by the Fianna Fáil/Progressive Democrats Government we were promised that a new era in Irish healthcare was beginning. The old health boards were abolished and the new structure was supposed to deliver the Government’s commitment to a “world-class health service”.
The Government Health Strategy had promised equity, a reduction in “the difference in health status currently running across the social spectrum”, and “access to service based on need”. Above all, the HSE was to provide better management. Introducing the legislation to set up the HSE, Health Minister Mary Harney, then still leader of the Progressive Democrats, enthused:

“It is our generation’s chance to put patients first in the design of the management of health services. It is our chance to put in place modern, effective management to make the best use of these tremendous resources we are applying to health and to get clear value and clear results for that money.”

Five years on, HSE higher management has been exposed as negligent and incompetent.
A shocking report from the Health Information and Quality Authority (HIQA) in July 2010 has shown how management in two HSE areas, Dublin North-West and Dublin North Central, were responsible for gross deficiencies in the protection of vulnerable children in those areas.
The HSE was found to have failed in its vetting, assessment and approval of foster carers, particularly relative carers. Almost incredibly, HIQA identified the “lack of recognition at senior management level that child care regulations exist to safeguard and protect vulnerable children”.
The result of this was that already vulnerable children were placed in unsafe situations and, in some cases, went missing when they were supposed to be in care.
The most damning finding for HSE management was that the problems have been known for years but were not addressed and thus, says HIQA, expose “serious deficiencies in the effectiveness, accountability, governance and management of these services, and the lack of emphasis on a child-centred culture at all levels of the HSE, but more significantly at senior management level”.
The fact that these findings were made about two Dublin areas but that a third area was found to be mostly safe and well-organised emphasised the need for management in the culpable areas to be held accountable. Sinn Féin Health & Children spokesperson Caoimhghín Ó Caoláin TD said: “HSE management heads must roll”. But nothing was done. The HSE announced that no sanction or disciplinary action was to be taken, prompting Ó Caolain to say further:
“It beggars belief that no action is to be taken by the HSE against management. The HIQA report clearly exposes neglect by managers, in contrast to the efforts of social workers who brought concerns to the attention of management but were not listened to.
“Questions must also be answered about the HSE agreement with IMPACT dating from 2001 which effectively allowed a situation to continue where Children First guidelines were not implemented.”
A month earlier, in June 2010, figures released by the HSE showed that 188 children died in the past decade either in state care or who were known to the social services.
The figures came at a time when the Government was cutting back social welfare, education and health services in a way that hits marginalised families and vulnerable children worst. These are the essential supports which help address child poverty and neglect. Undermining these services through cuts will condemn more children.
Another HIQA report earlier this year made a series of recommendations for improvements in Loughloe House, a HSE nursing home in Athlone, home to 26 elderly residents. HIQA did not recommend closure but on May 6th the HSE announced that it was closing the home. Severe pressure was put on relatives and residents to move out. Four residents have since died, others have reluctantly moved to other homes (all private) and 11 remain. They and their relatives and the local community are resisting a closure imposed because of the privatisation and cutbacks agenda of HSE management and Government.
The health services are mired in deeper crisis now through a fatal combination of fundamentally flawed Government policy, current cutbacks imposed as a result of the Government wrecking of the economy and dire management on the part of the HSE. Some will argue it is unfair to tar all HSE management with the same brush but if managers within the system can neglect children and old people and escape sanction surely it points to deep systemic failure?
We don’t have to go very far to see that systemic failure in action.
Just before the Dáil adjourned in July for its summer recess, severely disabled children, their parents and carers took to the streets to protest at Government cuts to respite services.
While these protests were going on, it was revealed that the HSE is to spend €1,000 per day to rent the third floor of a high-rise development in Carlow town while the local HSE-owned St Dympna’s Hospital has a huge amount of vacant accommodation. The HSE has signed a five-year contract to rent the third floor of the Shamrock Plaza at the cost of €365,000 a year. The HSE will move their physiotherapy, public health, speech and language and occupational therapy services to the high-rise office block from their current location at St Dympna’s Hospital. Carlow is another example of HSE mismanagement and bureaucratic waste, with the prospective landlord as the only beneficiary.
The public service recruitment embargo is hitting the health services especially hard and patients are paying the price. The Irish Nurses and Midwives’ Organisation estimates that if the current recruitment embargo is to remain in place over the next three years we will lose a further 6,000 posts from the health services. In other words, 6,000 posts will be unfilled with no distinction between vital front-line healthcare providers and administrators.
More than 40% of front-line nursing staff are over the age of 50 years; the pressure on the public system is leading to many early retirements and a further crisis in the supply of nurses is on the cards.
Cuts to hospital services continue.
At the end of May, the INMO estimated that there were over 1,000 acute in-patient hospital beds closed across the 26 Counties. That was before the summer cuts which included Accident & Emergency services being axed in the Louth County Hospital in Dundalk at the end of June, ambulance services removed from Monaghan at the same time, and further services shutting in Monaghan General Hospital during the summer. And that is only in one region.
Five-and-a-half years on from the setting up of the HSE, the Expert Group on Resource Allocation and Funding in the Health Service reported on July 9th. Despite the promises of half a decade ago, the report finds that there are still “serious inequalities in access to care” in the health system. These include high GP fees which deter many people on low incomes who do not qualify for the Medical Card from making necessary visits to their doctors. Another inequality identified in the report is faster access to hospital services for people who can afford private health insurance.
The report comes at a time when health has slipped from the top of the media and political agenda, as shown by the low-key coverage of the imposition of prescription charges (reported elsewhere in this issue). The Labour Party, basking in the media spotlight, has deprioritised health as a policy issue and has weighed in behind Fine Gael’s flawed plan for a totally insurance-based model of healthcare funding, an ill-considered recipe for privatisation.
Responding to the report, Sinn Féin Health & Children spokesperson Caoimhghín Ó Caoláin TD put it in the context of Sinn Féin’s demand for fundamental reform:
“While the report confirms the two-tier and grossly inequitable nature of the health system, it does not set out to remedy this. It proposes solutions supposedly based on better use of resources but without altering the inequitable and inefficient structure of the public/private, two-tier system.
“The report ignores what is, in Sinn Féin’s view, the best solution and that is universal provision of healthcare for all based on need alone. This would be free at the point of delivery and funded from fair general taxation. Tinkering with the current system is not enough.”

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