In focus: HSE’s latest makeover must involve tough choices and be much more than skin-deep
The HSE is the drama queen of the public service - forever in the headlines and always planning its next makeover.
Health Minister Simon Harris is expected to bring the latest proposal to remodel the HSE to Cabinet tomorrow.
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It is based on Sláintecare's idea that it be split into six modern-day health boards.
Revamping HSE structures has been seen as a cure for the ills of the HSE since it was set up in 2005 by Mary Harney.
So the public has a right to be sceptical about the promises that will flow with the latest big idea.
For all that is good about our health service, we should not be at a point in 2019 when 560,000 people are waiting to see a specialist and A&E departments are overflowing in the middle of summer.
If a plan for six regional healthcare authorities is adopted, hard decisions will have to be made to avoid overlap. This will require politically unpopular decisions to possibly axe jobs, bring in a redundancy scheme, amalgamate services and give the new bodies a proper budget and clout.
The top-level roles in the HSE will also have to be redefined, as will the job of the Department of Health.
When the HSE was set up, taking over from health boards, no redundancy scheme was implemented and efficiencies in the payroll were avoided. At that stage, the idea was that the creation of one national health agency would end the parish-pump outlook of health boards, dominated by local politicians.
However, instead of the "seamless service" promised, the HSE became a bloated bureaucracy, famous for managers' bonuses and decision- making lost in red tape. It was divided by regions such as HSE West or HSE South.
But that was then ditched when the Fine Gael-led coalition Government came in and former Health Minister James Reilly announced the HSE was to be abolished.
He also got rid of the HSE board.
The HSE was to be replaced by some very complicated quangos as part of the universal healthcare plan, with a huge reliance on health insurance companies. As health minister, Leo Varadkar then abandoned the universal healthcare insurance idea.
The HSE was then made up of nine community healthcare groups and six hospital groups.
It is fair to say a survey of the public would find many hard-pressed to describe the set-up of the HSE.
The board has recently been re-installed and once again the HSE is being readied for another remake.
The idea is to improve teamwork between community and hospital services, end duplication and move decisions about delivery of services nearer to local level.
The outline of the plan is still vague and, until there is more detail and debate, many will view it as yet another pre-election distraction.
Several of the hospital groups are still bedding down.
Although some groups are making the most of sharing services, others have still a way to go to fully utilise their network.
There is also considerable duplication of services in areas such as surgery.
The difference for this reshuffle is that reorganisation is being proposed in the wider context of the overall Sláintecare plan, which is to move more care out of hospitals to the community.
But whatever the future design of the HSE is, it will mean little if it does not also come with strengthened levels of accountability.
The old chestnut about the culture of the HSE and its failure to always learn lessons from tragedies and blunders is as much in need of an upgrade as any of its organisational structures.
It only recently launched its new policy on open disclosure to admit mistakes when something goes wrong.
But even as it was being promoted, the HSE failed to come clean on the fact that 800 women whose tests were sent for screening to the United States were the victim of a computer flaw and were not sent their results.
Once again time, energy and money is going into a review to find out what happened and who knew what.
If better systems of accountability were in place, there would be no need for a review.
The reshape has to go beyond deciding regional boundaries.