Rude health: Our lost leader
We lost the brightest Irish doctor of his generation to the UK, says Maurice Gueret, and political games were to blame
It's rare for the brightest doctor of a generation to be one of the nicest, but that was certainly the case for the late Professor Aidan Halligan, a gentleman I was privileged to know for many years. My first lessons from him were as a young medical student at Baggot Street Hospital, where he was a brilliant tutor.
Aidan passed away suddenly in April at the age of 57, having spent many years at the pinnacle of the UK health service. He was professor of obstetrics at Leicester, and rose to become Head of Governance in the NHS and Deputy Chief Medical Officer for England. In recent years, his focus was on encouraging leadership and improving health services for homeless people and in disadvantaged areas. Aidan was a great fan of Alice Leahy's Trust service in Dublin.
He was also the man who nearly became first leader of our HSE. Somewhere along the way, between accepting the job and taking office, he decided to stay put in the UK. In doing so, he spurned the doubling in salary on offer, and the chance to improve the health service of a country that he loved. His change of mind was a wise one. What became clear as day to him was that he was being offered a job that had all the responsibilities and none of the power. A situation that persists to this day. The HSE was created as a patsy, a stooge for government - always there for successive ministers and their mandarins in the Department of Health to hide behind. The HSE is a whipping boy for the healthcare of whim. It is the first and major casualty of an obsession with change for change's sake. Political games have corroded the service and demoralised the good people trying to deliver it. We didn't attract Aidan back to a leadership job he could have excelled at. He knew you cannot lead when you are bound with puppet strings.
In recent years, Aidan spoke his mind about various health services. His mantra about the Irish health service was that it was over-managed and under-led. He couldn't understand why ministers would spend millions commissioning reports from management consultants, when much better expertise was already on the health-service payroll. He was critical in Britain of a growing obsession with targets and box-ticking. He said that health targets had become an end rather than a means, and that politics had distorted healthcare priorities, promoting initiatives that were "built on little clinical understanding and massive over-management".
When British healthcare gets a cold, Ireland usually comes down with a nasty flu a few years later. We tend to be late in adopting political fashions. Our State's obsession with health targets is now beginning, just as other countries are getting rid of them. A quick look at the new contract GPs must sign, for €125 a year per kid, confirms much of what is wrong. Frankly, I find it demeaning and disgusting. There's an extra few bob for nagging parents who smoke. There are height and weight boxes that are already being ticked by the parallel public-health-nurse service. There's an extra €50 for each asthmatic identified. There are €25 bonuses for stuffing a bleeding nose, removing peas from an ear hole or freezing a verruca. Not to mention a whopping €62 if social workers call the doctor to attend a case conference. This sort of slot-machine healthcare is an embarrassment to a growing number of doctors who would rather be employed properly by a health service than moonlight as fee-per-item claim fillers. It's quite clear to any layperson reading this contract that the HSE does not trust family doctors and that this lack of faith is reciprocated, with bells on, by the GPs. The under-sixes will still be paying their pocket money to doctors in the autumn. I foresee a massive electoral headache for Doctor Leo.
'World Within Walls'
A friend arrived down from Monaghan the other day with a wonderful new book for me about its local mental hospital. World Within Walls is a history of St Davnet's, which has been providing mental-health services to the area since 1869. One passage caught my eye. In 1943, 40 young lads arrived at the hospital for interview. There were six 'attendant' jobs going. Matron measured and weighed all the men, and then passed them over to the RMS, who sat them all down in an examination room. The RMS, a psychiatrist, reminded candidates that smoking was not part of their test, and allowed them a minute or two to put out their fags. They were each handed a blank piece of paper on which they had to write their name, age, address and religion. The doctor then read out a passage from an anatomy book and asked the men to write down the spellings of particular words as he mentioned them. One candidate said that "most of them had never heard of those high-style words, let alone spell them". They were then requested to write a topical essay on progress to date in World War II. Some difficulty arose with the spelling of Russian cities. Finally, "for dessert" as the doctor put it, there was a maths exam with plenty of tricky questions. One participant, who passed the exam and worked in St Davnet's for the next 40 years, said it was a miracle anyone passed this "phoney test" at all! It was with some amusement that I discovered the psychiatrist in question was my late grandfather, Dr Billy Coyne. On his behalf, I would like to apologise to the young men of Cavan and Monaghan for the recruitment practices of yesteryear. My grandfather came up the hard way with a scholarship and always preferred the academic achiever to the political stroke-puller.
Dr Maurice Gueret is editor of the 'Irish Medical Directory'
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