Just more jobs for the boys
Promises of genuine reform made before the last election have failed to come to fruition. Instead, Minister Reilly is creating another HSE without the checks and balances, and filling it with his pals. Medical Independent column on 14 March 2013.
The entire governance of our health system is being dismantled under the stewardship of minister James Reilly. He got rid of the old HSE board within months of coming into office – the board members actually stepped down and were replaced by those he personally picked from the senior ranks of HSE and Department of Health.
Having senior people from government departments or state agencies on the board another state agency is contrary to all good governance practices, where board members are meant to be independent, operating solely in the interest of its stakeholders (in this instance the people of Ireland), and not the HSE nor Department of Health. One of the inquiries after the 1980s blood scandal recommended not appointing senior state officials to state boards due to the myriad of conflicts of interest. James Reilly is ignoring all such wisdom.
Cathal McGee also stood down as HSE chief. We don’t know why, but it is reasonable to speculate that he was being sidelined by the new minister and he felt his position was untenable. Tony O’Brien was the chosen one by the minister, appointed HSE directorate designate last July. Ambrose McLoughlin was appointed secretary general of the Department of Health last April after going through a public appointments process, but ultimately it was a political call to decide who to appoint from the pool of three shortlisted for the post.
Currently, five new HSE directorate positions are being recruited – Acute Hospitals, Primary Care, Mental Health, Social Care, and Health and Well-Being – from the ‘wider health family’. In other words you have to already be working in the HSE, the Department of Health or another major health agency to go for the job. The Chief Finance Officer post is being advertised through open competition. Why there is an open appointment process for this one post and not the others is inexplicable. Surely some outside experience in these new posts would be a good thing.
Once again, the minister made two unilateral appointments without any competition. Laverne McGuinness,currently director of integrated services is to become chief operations officer and Liam Woods, who was the national director of finance, is to become director of shared services.
The Health Service Executive Governance Bill 2012 is currently being debated and is going through the Houses of the Oireachtas. This lays out the legislative basis for James Reilly’s plans for the health system, including abolishing the board of the HSE and replacing it with a directorate, which will be made up of the director general and six directors. It also enables the Department to have control of the entire health budget from January 2014 onwards.
Critically, what the minister is doing is getting rid of any accountability and governance structures that exist and replacing them with a coterie of his men – and they are mostly men – in effect creating a command and control structure for the minister and those around him without any checks and balances in place. Given that it is government policy to abolish the HSE in its entirety in 2014/15, this new structure stinks of charade.
Speaking in the Dáil debate on this Bill, Roisín Shortall pointed out that this might be acceptable if the Minister’s plans were related to principles, but as she said, “we know from bitter experience, however, that neither the minister nor his cabinet colleagues operate on the basis of transparency and prioritisation when it comes to health spending…it would be the height of folly and highly irresponsible for this House to give these wide ranging and unfettered powers to a minister whose track record already concerns us”.
Given our mistakes of the past – the jobs for the boys, absence of accountability and good governance – we must learn this time round. This government came to power with the promise of a more transparent, accountable and efficient public administration. Yet, James Reilly’s actions in health are completely contrary to what we were promised.
Roisín Shortall is fighting a lonely battle. There needs to be more scrutiny of this Bill before it is enacted. Is it too much to assume that other public representatives might take on this mantle or that our leaders in the health systems – doctors, nurses and managers might cry halt?
Last time major health service legislation was driven through without any real debate or amendments, the monster that is the HSE was created. Surely HSE mark II without any checks and balances is another retrograde step that needs to be stopped, before further damage is done.