Mess is More for HSE

Drastic action is needed when it comes to our confused and disorienting health service, argues Conor MurphyThe recent HSE-related scandals about missing training funds and money not spent on care was really a more-of-the-same story, and the media reacted with familiar enthusiasm. The way they see it, death sells. For papers, newsagents and TV stations, nothing makes a good political scandal like a few dead people – women and children first. If you can toss in a few heartbroken husbands or mothers, then all the better.The problem with these town-crier-style headlines is that they draw away from the real complexity of the issue; the issue of the many layers of gross incompetence in our health service. To start a rational debate on this matter, you must not give a damn about that one sick mother or father or child. You must look uncaringly at human pain and decide what is best, for the numbers alone., because sob stories just make bad policy.Simplicity is key. A streamlined service with a simple chain of command is a must. But this chain is far from simple at the moment.At the top rests the ineptitude of Minister for Health Mary Harney. Watching her defend herself in the Dáil is watching a person who seems oblivious to her failings. You start feeling physically pained every time she says that something is “the responsibility of the HSE”. Any good manager knows that your subordinates’ failings are your own. The HSE is simply her cast aside responsibility. The Organisational Review Programme noted something similar last week, saying that management was poor and that staff were unevenly allocated.I have parents who worked in separate Health Boards. They had different forms and rules for the exact same procedures before the HSE was created. This doubled paperwork, and hence increased the number of civil servants employed. But then the HSE arrived, and the forms and the procedures stayed as they were. The letterhead did change to a wonderful new marketing-made logo. Why does an administrative body that needs real change only get a new logo? What has the HSE simplified? Make no mistake, simpler always means cheaper.The Chief Executive was Professor Brendan Drumm, before eventually stepping down on September 1st of this year. But why was a doctor ever made head of the biggest company in Ireland? I don't want my head of health to specialise in individual patient care. I want him to care about dividing resources as well as possible and to be an expert in that field.In the Organisational Review Programme last week, it was noted that the best managed, yet most understaffed sector, was the Revenue and Tax Office. This is because organisation is their professional occupation and training.In my wildest utopian fantasies, Michael O'Leary is Chief Executive of the HSE. Whatever reservations certain people may have about his character, he is a brilliant manager.  Hand him the current health budget with one objective – the lowest death rate possible, for example – and he would more than likely achieve said aim.O’Leary would ignore the publicity surrounding dying tabloid-attracting patients to secure the funds for the survival rate of the living. He’d stare at the lines of doctors protesting for “changes in work practices” and turn every newspaper against them with his brutal media tactics.Furthermore, O’Leary would reduce most of the endless form filling which doctors are obliged to do, so they can get back to actual work. He would also ignore the proposed and pathetic “retrain the useless” program of Fine Gael and just fire the useless. If you can't figure out what your job is, then say so, and stop stealing taxpayers’ money.The Minister for Health has consistently ignored calls for simple cost cutting. While cutting payments to pharmacists, the pharmacists pointed out that cutting one simple law would save far more. Did you know that pharmacists legally could not tell you of a cheaper branding of the exact same drug? Two years later, Mary Harney suddenly announced this same law reform as a new amazing policy. That's more than a year of millions being lost during a recession.Who would notice that a paltry four million of training funds going missing among the mess of bodies and ministries?The new chairman of the HSE, Dr Frank Dolphin, has started on the right path by targeting simple absenteeism to save “easily more than €100 million” and the moves to cut 6,000 voluntary middle management and administrative staff. But this needs to go much further.Firstly, cap pay for the next four years at a generous €200,000 for everyone, including bonuses and overtime. Secondly, make a rule that any head of any department who fires anyone for not being useful enough in the next year gets that wage plus ten per cent back in their budget for actual treatment of patients. Finally, hire a group of the biggest businessmen and women you can find to run the behemoth.Only cold, non-caring number crunchers can beat this level of human incompetence.