Wednesday 22 November 2017

Hospitals plan is 'bound to fail'

Obstetrician accuses Health Minister of putting economics before decent health services

Barry Duggan

AN experienced consultant has strongly accused Health Minister James Reilly of putting management systems and economics before decent health services.

Obstetrician Gerry Burke, who works at the Mid-Western Regional Maternity Hospital, said the proposed incoming management system for hospitals in Limerick, Clare and Tipperary has left him extremely disappointed and is guaranteed to fail.

Last Wednesday, Dr Burke attended a meeting of the regional hospital's medical board where Mid-western Hospitals' Group CEO Ann Doherty presented a discussion paper on a new management structure.

However, in a letter to all his local TDs after the meeting, Dr Burke warned that what is "currently being proposed amounts to rampant managerialism" and castigated the proposals. He said the "emphasis is clearly on managerial processes and economism, rather than on the community's need for decent clinical services".

Dr Burke is chairman of the Labour Party in Limerick city, and was at the constituency's referendum count on Friday at the University of Limerick arena along with party colleague and cabinet minister, Jan O'Sullivan.

Following Wednesday's meeting, Dr Burke said the current thinking for a new management structure for the region "seems to favour a single executive, composed of the CEO (a manager); the chief financial officer (another manager); the chief operating officer (another manager); the human resources manager (another manager); the senior nursing and midwifery manager (another manager); and a senior clinical director (a doctor)." He said it will not include the four clinical directors for surgery, medicine, maternal and child health or diagnostic services.

In his letter, he said as part of "the misguided focus from the Health Department, the new executive will include a human resources manager, but will have no place for the clinical director for diagnostic services (X-rays, scans, blood tests) or clinical director for maternal and child health."

"While it will be argued by management that the organisation will have a staff of 3,000 for the HR manager to supervise, it should be borne in mind that every year these hospitals will provide diagnostic services to a population of 380,000 individuals, maternity services to some 6,000 mothers and paediatric services to some 30,000 children," he said.

"That it can be even suggested that the HR manager's role is more important than that of the clinical director for maternal and child health defies credulity," Dr Burke wrote.

"As the plans are revealed gradually, it is becoming obvious that what is intended is a sort of mini puppet-government for the hospitals that will have very little or no local democratic say-so, one that will be answerable to the Health Minister rather than the local community and that will continue to rely on Department of Finance funding," he said.

"While I appreciate that this remains very much a work in progress, and what was presented (last Wednesday) is a discussion document, none of it is very promising. The new system is being designed in a way that makes failure inevitable -- it is guaranteed. In effect, what is being proposed is a dwarf version of the HSE with most of that failed entity's faults built into it and reinforced."

Earlier this year in the Dail, the Taoiseach launched an attack against the senior medic after Dr Burke warned that the loss of 47 midwives from Limerick Maternity Hospital could cost lives. Enda Kenny said Dr Burke's comments were "outrageous".

Dr Burke said that when he first came to work in Limerick as a young consultant 20 years ago, he was encouraged and expected to be a defender of the health service on behalf of the local community and a partner of the minister and the health board. "It was through that mechanism that the paediatric department was prioritised for attention, which it received finally under the stewardship of Michael Noonan as health minister. This no longer happens," he said.

"It seems to me that one of the worst effects of the HSE has been the fostering of a virulent form of managerialism that, far from encouraging consultants to defend their community, it actively discourages them. The cost of that may be difficult to count and the damage may not be apparent for a few years yet, but it will be very expensive," he added.

Dr Burke has called on all local public representatives in Limerick, Clare and Tipperary to wrest control of the region's acute hospitals away from the people in Dublin. "They must take them back into local democratic control before more damage is done."

A HSE spokeswoman said consultations on the proposed management structures were ongoing and the HSE would be making no further comment at this stage.

Sunday Independent

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