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HSE needs treatment but it may be worth saving after all

I've just left St James's Hospital in Dublin, and let me tell you it was some experience. I know you're expecting a sad and sorry tale that will take up all of this column, and half of next week's, but actually it was astonishingly good.

Briefly, it involved accompanying a visiting elderly relative (a medical card holder) to the x-ray department. She had been sent to St James's by my GP following a car accident. The doctor told her there was a walk-in service, and the wait would be about half an hour. Needless to say I snorted when I heard that.

When we got there we discovered that it was not one of the walk-in days, but nonetheless they would see her. She was x-rayed within 15 minutes of arrival. We were told the result would take around 40 minutes, or so, but in fact it was well over an hour. They were terribly apologetic about this, saying someone had been called away. Actually the members of staff we encountered couldn't have been more pleasant.

Ten minutes after arriving back home my mobile phone rang and it was my GP, who had already heard from the hospital -- to tell us what we actually already knew -- that everything was clear. The hospital's efficiency was so unexpected as to make it all the more astounding.

For the purposes of disclosure, though, I should add that a friend had an elderly parent admitted to St James's recently, and while the care was generally really good, she found the hygiene sadly lacking, not least the state of the shower plug hole which she said had to be seen to be believed.

Another friend recently had major surgery in Tallaght Hospital. You hear so many scare stories from that institution that I'd almost be afraid to go and visit someone there, let alone receive treatment.

But, much to her surprise, she could not speak more highly of the care. We agreed, though, that neither of us fancied, under any circumstances, having a visit to their A&E.

I've written some time ago that I know of women who have undergone breast cancer treatment in St Vincent's Hospital in Dublin and they are also generous in their praise.

What does all this mean when it comes to our health service? or does it mean anything at all when you contrast it with the relentless barrage of horror stories we seem to hear on a daily basis?

It's everything from trollies on corridors to missed liver transplant operations; patient files in bins; shortages of junior doctors; various misdiagnoses scandals; and all the other maladies that make up our "third-world health service".

The letters HSE only have to be mentioned and outcry is guaranteed.

We all know that if a representative of that particular organisation told us it was raining it would be wise to check the veracity of the statement by looking outside yourself.

There is so much wrong with our health system that it's hard to know where to start the analysis -- it contains almost 25 separate financial systems making it impossible to keep any kind of hold on where the money is at.

The management structure is such that people at local level are afraid to take decisions, so often a problem can grow out of all proportion. Its IT system is so antiquated that even the most basic questions that would contribute to running a more efficient system can't be answered.

For the questions that can be answered, none of them are in real time, you have to wait until end-of-year reports when it's discovered the budgets have already been hugely overrun. So much of this could be solved by the introduction of even the most basic of IT systems, but after the PPARS fiasco it's the proposal that dare not speak its name.

It's a really good thing that Health Minister James Reilly is so determined to abolish the HSE, and no better man to carry out the threat. Or, wait, is it as good an idea as it seems? Maybe getting rid of the HSE is not the answer to all our prayers.

This column comes with the health warning: It is impossible to know exactly how our health service is run, so therefore impossible to know precisely how it might be fixed.

But am I mad to wonder if the HSE, which came into existence in 2005, has actually learnt something from all its travails? Is it daft to speculate that perhaps its new chief executive Cathal Magee, only a year in the job, might have the skill to kick the entire operation into some shape?

It's hard to know how much of this abolishing of the HSE is just about optics. The Programme for Government says the HSE will cease to exist eventually as its functions are given to the Health Minister and the universal insurance system.

The real issues here are whether the minister gets cracking on the fundamental reforms of the health system that are so badly needed, and how he fares introducing the much-vaunted universal health insurance scheme.

He needs to be a little less gung-ho though, as do the media, which survive and thrive on health scare stories. These are often justified, but frequently also involve exaggeration. This means the overall debate on the best future for our health system never really gets off the ground.

It may be that the best decision ultimately is to give the HSE the boot, but even if it is, we need some rational, informed discussion about how we are going to replace it.

Irish Independent