Thursday 20 October 2016

For Grace's sake, we can't accept it anymore

The system silenced 'Grace' by abandoning her. We have to believe there is a better way to run a health service, says Brendan O'Connor

Published 07/02/2016 | 02:30

SPEECH: Enda Kenny spoke touchingly on the failures in the system, but now it’s time the bumbling behemoth that is the HSE becomes an election issue. Photo: Gerry Mooney
SPEECH: Enda Kenny spoke touchingly on the failures in the system, but now it’s time the bumbling behemoth that is the HSE becomes an election issue. Photo: Gerry Mooney

One of Enda Kenny's great strengths is the emotional intelligence he sometimes demonstrates at moments of national crisis or shock. He spoke beautifully last week about the deeply upsetting case of 'Grace', the young woman with an intellectual disability who was left to be allegedly brutally abused for over a decade after a decision had been made to remove her from the foster house where she lived. The phrase 'foster home' would do a disservice to what Grace is understood to have endured.

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In one of those speeches where he seemed to speak for all of us, Kenny said: "The words do not exist to describe, adequately, the depth and the volume of the revulsion we feel about the alleged abuse and failures we've heard of ... Grace, because of her condition, was silent. But by her treatment and her abandonment she was silenced.

"Those who left her to her fate, pressed the mute button on her young life and appalling experience. Above all, they pressed that mute button on her dignity, her humanity, on her civil and human rights, on her innate worth as an innocent, precious, fragile life on this Earth."

Kenny went on to question the system's role in Grace's living hell: "The question is, in ticking its boxes, was the system blind, was the system deaf, did the system possess so little awareness, so little accountability, that it could become a stone to Grace, to her abject experience, to her desperate need?"

He spoke of "finding and re-establishing our coordinates, as a functioning, moral and responsible society... Because in every procedure, in every system, in every action, taken in regard to Grace and others, there is not just a sense of public authority, crucially there is one of personal moral autonomy."

He went on to promise that we would get to the bottom of what went on through an inquiry, saying that: "I believe it is the best and most thorough and powerful way to treat them with the grace and the respect and the kindness, of which their experience, their lives in care, were so devoid. If Ireland was declared by Yeats to be no country for old men, the legacy issues I have just mentioned suggest it was positively treacherous, and at times omnipotent, when it came to our girls and women."

Powerful words. And words that would be full of a righteous anger that we could all identify with. Except that Enda Kenny is the Taoiseach, and has been for the last five years. This is not to suggest that Kenny is responsible in any way for what happened to Grace and potentially to over 40 other people who passed through that house.

However, what we can say for sure is that this Government has done very little to try to tame the wild beast that allowed this to happen, which is our out-of-control health service.

The story of Grace is another catalogue of HSE impotence and unaccountability. Why did no one from the HSE visit that house for six years between 2001 and 2007? Why was the decision to get Grace out of that house in 1996 reversed after the foster family appealed to Michael Noonan's Department of Health? So that Grace stayed there for another 13 years enduring God knows what, long after the HSE stopped placing anyone else there. Why did no one seem to take into account that Grace was not attending day services, and, when she was, her behaviour was highly erratic and disturbed? Why did no one intervene when it became apparent on one such visit that she weighed only five stone? Why did the HSE also fail to get Ann, another woman who was privately placed in the house, removed? Why did they not convey to Ann's family the seriousness of the allegations, and the nature of them? And why are people who were involved in this appallingly botched case still working for the State in the area of child protection?

The answer, as always with the health service, is a mixture of incompetence and typical corporate-legal bureaucratic wrangling.

Ann's family couldn't be informed there was suspected sexual abuse going on at the house where they sent their vulnerable daughter for 12 nights out of every fortnight because of legal advice pertaining to the garda investigation into that same abuse. No one in the HSE has been disciplined or fired because we are awaiting the outcome of other investigations and inquiries. Things were compounded by the fact that because Ann became an adult during this saga, the HSE had no legal responsibility for her.

So there is a baseline level of incompetence, and this is then compounded by everything getting tied up in legal knots so that common sense and the ability for anyone to take the actions needed to fix a situation become impossible.

And the really depressing thing is that none of this surprises us. Because there is a conventional wisdom in this country now that our health service is a basket case that can't be fixed. It is too big, too complex and too hamstrung by legal and HR considerations for anyone to be able to do what they need to do to fix it.

And we accept this. And we accept that nothing has changed in the past five years. We take it for granted that the Minister for Health basically throws his hands in the air about problems, acting like some kind of health critic, looking on from the outside wringing his hands.

Varadkar has been better known during his tenure in health for telling us what isn't possible than for trying to widen the spectrum of what is possible.

Now, as the Government seeks re-election, they suddenly have all kinds of plans for the trolley crisis, though these seem to revolve around changing the metric by which we measure it from a trolley count to a customer experience audit.

If you were cynical you could just say it's more corporate bullshit. And you could ask why they didn't do this five years ago.

Corporatism is one of the great cancers that dehumanises how business is done these days and it has infected the public sector more and more too. When Enda Kenny asks, in his glorious humanity: "Was the system blind, was the system deaf, did the system possess so little awareness, so little accountability, that it could become a stone to Grace, to her abject experience, to her desperate need?", he seems to be pointing the finger at that very cancer, the systemic sclerosis of corporatism that turns human beings like Grace into "service users" and apologises to them as a "service provider" that failed to provide an adequate service, as if she was left waiting too long for her coffee in Starbucks.

Anyone who has had to "link in" as the jargon goes, with the "services" and has had their baby or loved one referred to as a "service user" knows the dehumanising effect of this kind of corporate speak. The fact that the services are pretty much non-existent for many people like Grace, and focused instead on getting parents and loved ones to provide all the "services", doesn't help either.

But if corporatism has been the ruination of our health service, then perhaps we should be looking to the corporate world for the answer too.

Businesses ebb and flow but some of the biggest names in the world are companies that have reinvented themselves, pulled themselves out of crisis.

The Ford Motor company was in the doldrums twice, once in the early years of Henry Ford and once in the late 70s as Japanese manufacturers stormed the motoring world.

On both these occasions Ford turned itself around. Apple, McDonald's, IBM, US Steel, Nissan, are all companies that have had to reinvent themselves at least once in their lifetimes to bring themselves back from the brink of irrelevance and extinction, and indeed they will all need to do it again. All these companies were turned around by good leadership, leaders who acted decisively and came up with realistic road-maps back to success.

It is no longer enough to keep throwing our hands up and accepting what an out-of-control behemoth of a shambles the health system is. It is no longer enough to think that it is incorrigible and that it can be no other way. Organisations, no matter how big, transform themselves all the time. We need to believe that this is not only possible, but necessary and urgent.

They say that in reality health is not an election issue. Irish people basically vote on what's in it for them, in terms of cash money. But maybe health should be the big election issue. Maybe the next government needs to be the one that will truly transform the health service, put the right leader in there and empower him or her to follow his road-map, getting all the potential HR and legal cows on the line out of his or her way. I know you're getting a headache even thinking of it, but it can be done and we have to believe, for the Graces of the world, that it can be done.

Sunday Independent

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