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Niall Hunter: Even the head of the HSE says it's time for an inquiry

Professor Brendan Drumm has just called for a review of the HSE he heads. And it's not a minute too soon.

Five days after the country was convulsed by news that almost 58,000 X-rays taken at a busy hospital were left unread, we heard our first comments from Professor Drumm -- when he revealed he only learned of the problem around the time the rest of us did.

It is hardly a ringing endorsement that the two most important people in the system, Brendan Drumm and Mary Harney, first heard of a hospital crisis the day it broke in the media.

But Prof Drumm's statement is also confusing, in view of the previous statement by Tallaght's CEO, Kevin Conlon, that on hearing of the scale of the X-ray backlog in mid-December, he immediately contacted the HSE.

Mr Drumm also said the HSE does not have a role in the day-to-day operations of voluntary hospitals like Tallaght and there is no imperative to inform it of any service backlogs.

Surely it should be the most basic imperative of any system that backlogs, especially when they have safety implications, should be picked up at the earliest possible stage and sorted?

It is deficiencies like these that typify the fault lines in the health service.

The different components simply don't seem to talk to each other, even when there is something glaringly wrong.

The Tallaght crisis has demonstrated that we have a system where the Minister and her Department are often left in the dark about major flaws in the provision of healthcare.

At the same time, the agency running the service is often unaware of key warning signals emerging in individual hospitals.

It seems unbelievable that nobody seemed to grasp what the potentially disastrous safety consequences might be of ongoing difficulties with X-ray services and GP referrals -- until it was too late.

Plenty of people in the hospital acknowledged there were problems, but nobody saw how big those problems were.

And that's the heart of the problem: a Department and Minister who no longer run the service and often have little idea of what is really going on, and a health executive that has a limited role in the day-to-day running of many of the hospitals it funds and is supposed to oversee.

A key problem is that while the HSE owns some hospitals, many of them, the traditional voluntary hospitals, are still legally independent of the HSE, even though the taxpayer almost completely funds them. This relationship needs to change.

Brendan Drumm has also admitted that, five years after it was set up and a few months before he is due to step down, the HSE could do with an independent review of its effectiveness.

This is the first time, to my knowledge, the CEO has admitted that the HSE might not have been the success story he and others running it often say it is.

Many would feel that in 2005 we went too far in moving from 11 health boards to one agency.

To many, the HSE is a failed entity that needs to be reformed.

Brendan Drumm's call for a review of the HSE is overdue.

Hopefully, out of such a review will emerge a new structure, that will be more sensitive to patients' needs.

Separate to this, we need a proper safety system, with regular inspections of hospitals. The threat of losing their licence to operate would be a great incentive for hospitals to get their act together.

Niall Hunter is Editor of irishhealth.com