Time to end kid-glove treatment for failing managers in the HSE - what we need is genuine accountability
The recent announcement of a new performance management and accountability system for HSE managers is designed to reassure the public that the HSE and Health Minister Simon Harris are determined to deal with recurring, serious failings in our hospitals and community social services.
Mr Harris talked tough, saying he would go after underperforming managers and have them removed from their roles.
The main trigger for this new accountability framework was the admission by the HSE, nearly two years after the report into infant deaths in Portlaoise Hospital severely criticised several layers of management, that it did not have either the supporting legislation or HR procedures to hold managers accountable.
Serious incidents and managerial failings are so common in the HSE that we easily forget.
For example, nine individuals missed 13 opportunities to intervene as they should have done, leading up to the death of Savita Halappanavar. This was patently not so much a case of human error as a failure of management, a failure to put in place new protocols for handling such crises that had been defined two years earlier, following the death in similar circumstances of another woman.
The latest in what seems like a weekly catalogue of managerial failures is the HIQA revelation that some hospitals have no system for managing safety in the dispensing of medication, some have an excellent system and the rest are somewhere in between.
The "error" of a HSE counsellor in cutting and pasting an allegation of child abuse into the file of a Garda whistleblower is now being investigated by the Charleton Disclosures Tribunal.
Also this week two reports on the case of "Grace", the intellectually disabled child left for years in an abusive foster care setting, cry out for managerial accountability.
The HSE has never had a mature system of personal accountability for managers and, regrettably, the new regime will not change this situation.
On closer scrutiny, it is clear that it will not transform an embedded culture of impunity within the management system of the HSE because it is not envisaged that delinquent managers will be fired or suffer a financial penalty.
Incompetent or negligent managers will be moved to another role or sent on a development programme while remaining in their current positions.
This approach is similar to the discredited PMDS (performance management and development system) rolled out in the wider public service more than 10 years ago. It is reported that the Department of Public Expenditure and Reform assisted the HSE in designing the new system. In its own excellent paper of January 2014, DPER itself defines accountability as follows: "The original and long-standing meaning of accountability and its conventional usage in Ireland ... is… the formal obligation to submit to a mechanism designed to achieve external scrutiny in explaining and justifying past conduct or actions, with the possibility of consequences arising."
If the only "consequences arising" are a sideways move on full salary with perhaps a development programme thrown in, this kind of kid-glove treatment will not cut through the culture of the HSE, no more than it would in An Garda Síochána. A sideways move to a less onerous job on the same pay, and the real prospect of annual increments or even promotion (as in AGS) will not act as a deterrent in the future. In effect, it constitutes a reward for failure.
It is important to ask why is there a reluctance to establish a mature system of accountability, as in other parliamentary democracies.
There are two main reasons. Firstly, the infrastructural supports that managers need to carry out their roles effectively, such as finger-tip information, necessary training, unambiguous structures of accountability or HR tools to deal with absenteeism and poor performance are extremely patchy across the health service. Crucially, in many areas managers don't have the resources of money and staff to do a good job.
In these circumstances punitive sanctions against a manager would prove hard to defend. Even allowing for these mitigating factors, however, many grave, culpable management failings have occurred that require more than a slap on the wrist.
The second reason why successive governments have failed to install effective systems of accountability, with consequences arising, is what has been called the "Faustian pact" whereby, in the words of Pat Rabbitte, at the apex of our structures of governance, in the relationship between ministers and senior public servants, we have a system that is "grounded in a lie" such that "civil servants can hide behind the skirts of ministers" and "ministers can avoid responsibility".
As long as officials 'go along to get along', knowing that some of the promises made by the political system are not achievable, the problem of accountability will persist. Tusla, for example, trumpeted as the game-changer in the care of vulnerable children, was never given the resources it needs to fulfil its mission. Today over 5,000 children deemed to be at risk have no assigned social worker.
Civil servants and agency managers routinely accept responsibility for implementing political promises, saying at the time that "it is going to be challenging", while knowing in their hearts there isn't a hope in hell of delivering. It would represent a great step forward if public servants at all levels were to adopt the sentiments expressed by Tony O'Brien, CEO of the HSE after a grilling by TDs in early 2015, for failing to achieve the impossible.
"In future I think the HSE will have to be more careful about what we accept responsibility for."
Eddie Molloy PhD is a management consultant