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My analysis government’s failure in the setting up of the HSE and Irish Water

From the Irish Independent on 22 November 2014.

So the Government established a new national entity to “use the resources available in the most beneficial, effective and efficient manner to improve, promote and protect the health of the public’. To do so, they were going to “invest in infrastructure . . . by rationalising . . . services to reduce fragmentation . . . by establishing a single entity . . . to manage… services”.

This could easily have been Phil Hogan in the Dail on the establishment of Irish Water, but, oh no, these are the words of the health service reform programme in advance of the establishment of the Health Service Executive (HSE) more than 10 years ago. This was the very rationale for the HSE, conceived under the leadership of Micheal Martin, and inadvisedly rushed through under the stewardship of former health minister Mary Harney.

It’s hard to argue against the logic of either the HSE or Irish Water. Just as it did not make sense for 11 politically driven health boards to run our health system, it did not make sense for 34 local authorities to run our water services. By their nature, the local fiefdoms were unfit for purpose, overly interfered with by local politicians and ensured national incoherence and inconsistency. In effect, they competed with each other against the public interest.

Despite the fact that both these agencies are essential to everyday living, somehow our wise leaders managed to make both these essential public bodies toxic before their very establishment.

Both were fundamentally flawed from their inception, driven through for political expediency without the necessary thought or planning. They were both rushed through the Dail in guillotined debates in the days before Christmas (in 2004 and 2013), which prevented a proper consideration of the plans, amendments or debate.

Their new incarnations were meant to ensure a rationalisation, yet each of the 11 health boards and 34 local authorities were merged into one entity without one person losing their job. Rationalisation certainly did not happen at middle management level – when the HSE was formed there were 380 grade eights, three years later there were 550.

The first two CEOs of the HSE, Brendan Drumm and Cathal McGee, were paid €322,000. Brendan Drumm even received a handsome bonus of €70,000 in 2007. Tony O’Brien, the current CEO of the HSE, is on €185,000. Now all HSE staff are paid less, while many staff there in 2005, including those in middle-management positions, are no longer there. But that was driven by the economic austerity measures, not the HSE reform. While much has improved in the HSE, all is still not rosy.

 Ten years on from the establishment of the HSE, the very reason for its establishment has not been achieved as there are still huge variations in access and quality of services dictated by where you live.

Just a month ago, the HSE launched another new structure which is meant to manage all parts of the health services outside of the hospital groups. Under this plan, there are nine Community Health Organisations, the same number of regional structures as there were before the HSE was founded – a damning admission of its flawed design. Quite simply, we have a woeful track record in large-scale public sector reform, where political self-interest or incompetence seems to win out over the public good.

Conveniently, the focus on Irish Water has shielded the Government from public anger over the removal of discretionary medical cards.

Remember, the Government did a U-turn on medical cards too. Having ‘listened to the electorate’ on the doorsteps, they re-instated 15,000 discretionary medical cards and kicked to touch on the issue. Now the experts have advised the Government with an excellent, as yet unpublished, report that was meant to go to Cabinet weeks ago. But it only went to Cabinet this week as our political leaders were so damn distracted by Irish Water.

There are similarities between these too. When medical cards emerged as an issue over a year ago, the HSE launched a new website and other measures, but the medical card problem was nothing to do with clarity or communications. Some 30,000 people lost their discretionary medical cards and no amount of spin could change that and eventually the Government caved in. Similarly with Irish Water, the people who are protesting are not looking for certainty or clarity or better communications, they just cannot afford to pay for water – or they just don’t want to.

Will our politicians ever learn that politics should be driven by the public interest? That policy should be made in the public interest? And that each requires vision longer than the next electoral cycle. And when it is not, the people ‘get it’ even before they do? The track record of the formation of the HSE and Irish Water indicate not.

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