Thursday 20 June 2019

Ten things we could do if we really want to fix the HSE

How do you solve a problem like the HSE? Maurice Gueret comes up with a handy list of suggestions...

Vicky Phelan: Women have been watching how the State has reacted to this whole scandal, and they don’t like what they see Photo: Fergal Phillips
Vicky Phelan: Women have been watching how the State has reacted to this whole scandal, and they don’t like what they see Photo: Fergal Phillips

Maurice Gueret

1 Change the name. Let's face it. Nobody loves the Health Service Executive. It's a dreadful name. Like the Authority before it that proved to have no such thing.

The word 'executive' conjures up images of managers, administrators and endless diktats. I'm sure we can come up with a better name. The HSE is almost 14 years old. Abandoned by its parents (Micheal Martin and Mary Harney in case you have forgotten). Threatened with extinction by Dr Reilly. Resurrected by Dr Varadkar. Warned last year that it would be 'dismantled' by Mr Harris. No wonder it's feeling unloved and uncared for.

I'd give it a good wash, some new clothes and a fresh start. Let's give it a kinder title we might grow fond of. Curam is the Gaelic for care. Curam Ireland, Curam Eireann, or Curam All. I'll take any of those.

2 Slim down its role

Want to get married? Think HSE. Yes, the Health Service Executive marries people in civil ceremonies every day of the working week.

In Carlow you contact the HSE at St Dympna's Hospital. In Sligo you contact the HSE Community Care Office. In Meath it's the Community Enterprise Centre.

I don't want the same organisation marrying people in the morning and removing haemorrhoids in the afternoon. When the wedding party has departed, the HSE is off inspecting cruise ships, airplanes and creches. In the evenings they are down inspecting the back of fridges in Chinese take-aways. Let's get some focus back to the HSE. It can't do everything.

CLARE DALY: She would be excellent on a new board
CLARE DALY: She would be excellent on a new board

3 Duel at dawn with the Dept of Health

Ireland's a small wee place. When you have an organisation like the HSE with about 130,000 employees, the last thing you need is a jumped-up kid brother nearby with a couple of hundred staff pretending to be doing the same thing only better.

The HSE and Department of Health have been bickering like kids in the back of the car for years. I'm told that the Department doesn't like the HSE to contact the Minister directly. They see their role as some sort of filter. In recent weeks we found out that they weren't very keen to 'escalate' life and death issues to ministers concerning women who had smear tests.

However they are quite keen to escalate photo opportunities and ribbon-cutting events at every opportunity. The claim is that the Department does policy and the HSE delivers services. If a slimming programme is warranted, I'd start with the Department.

Slim it down until it's the compact size of a Minister's office. Let the rest be part of the HSE.

4 Join the dots

Much of what the general public sees as everyday health services act independently of the HSE. General practice is a contracted-out business, as is pharmacy and most nursing home care. Indeed, many of our hospitals, especially in Dublin are voluntary hospitals that are not governed by the HSE.

There is a great reluctance among all of these sectors to have the State take over their functions. This is due the fact that many health professionals distrust the corporate HSE just as much as patients. Politicians like to promise a seamless health service. Those who work in it see Johnny Fortycoats lying under a patchwork quilt.

5 Re-visit Canada

Remember when Dr James Reilly promised us a Dutch health service? We were all going to be blue eyed and blonde riding our bicycles in clogs through the tulips to hospitals powered by windmills.

It didn't happen. The lead-in period was so long that insurers all hiked up their prices. Leo pulled the plug and said the whole idea was unaffordable.

I remember the debate well. Not all commentators agreed about the Netherlands model. The Canadian health service was more interesting. Most front line medical services are free to access and funded through universal insurance. All citizens are in a safety net. The private sector delivers many of the services, but are well supervised in each province and profiteering is discouraged. Middle men and state bureaucracy are kept to a minimum. More than 85pc of Canadians express satisfaction with their health service.

Leo needs to get jogging again with Monsieur Trudeau.

6 Emphasise the positives

Lots of good work is done each day in the HSE. Public health nurses are a lifeline for hundreds of patients in their own homes. They do child immunisations in primary and secondary schools all over the country. Infectious outbreaks are well managed by local public health doctors. Community mental health teams, though poorly funded and resourced, deliver vital services to vulnerable people with acute and chronic psychiatric illnesses.

We don't hear their stories very often. Too often healthcare only gets attention when scandals hit the news or difficult cases reach courts. Good journalism isn't always about bad news.

7 Appoint a new board

I served time on a health board and health authority just before the HSE monolith came into being. It was an experience.

There were too many local politicians who used the position for expense-filling, electioneering and grandstanding.

They divided along the usual party lines and played politics by jockeying for positions of power and extra dividends.

On the much-trumpeted Eastern Regional Health Authority there was only one nurse and about 40 county councillors. It was doomed from the start. If the HSE requires a new board this year or next, I'd certainly give membership due consideration. But I'd want to see its make-up in advance.

Boards don't work when too many agendas are brought to the table.

8 Start loving the health service

Remember when the Olympic Games in London in 2012?

The opening ceremony featured a dazzling tribute to the doctors, nurses, patients and founding politicians of the British National Health Service. They love their NHS across the pond. They know who founded it (Aneurin Bevan). They know why he founded it (poor families couldn't afford to bring sick children to doctors). They know how it has provided a cradle-to-grave health service, warts and all, for 70 years.

Nobody in Ireland seems to remember the conception of the HSE. Few even own up to being there at its birth.

If you want the public to like you, you must give them something to like.

9 Change the culture

Clare Daly TD hit the nail on the head last week when she made the most effective Dail speech on healthcare I have heard in many years. It concerned the paranoid state that exists in health services about the possibility of being sued.

She spoke about how health providers are obliged to tell the State Claims Agency about adverse events within 48 hours, but are not obliged to tell patients. She told us that almost €2bn worth of claims are currently being taken against the State, double the figure of five years ago.

She spoke about families that cannot afford the thousands of euro they need for expert reports on their injuries. She urged the government to change the culture, bring in no-fault compensation, and take lawyers out of our hospitals.

Just the sort of person we need on the new board of the HSE.

10 Get involved

It's easy to moan about the HSE and its health services. I should know. Too many of us, myself included, waste time on Twitter liking the negatives and retweeting the obvious to the already converted.

I visited the newly named Tallaght University Hospital recently and was overjoyed to see how local people, in competition with Starbucks, still run one of the coffee shops in the main concourse. The chat is mighty, coffee and food is good and cheap, and you can buy second hand books or dvds on your way out.

The local hospice in Harold's Cross also uses a volunteer service. They recruit people to read to patients, help them with transport, make tea, or help nurses when they are busy.

Getting involved with your local health service is much more rewarding than moaning about it. I'd like to see a bigger effort from the new HSE to encourage volunteerism. Let's give people a stake in their own healthcare service.


Dr Maurice Gueret is a GP and former Health Board member and member of the Eastern Regional Health Authority. He writes a weekly column on medical matters in the 'Sunday Independent' LIFE magazine

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