The 1973 Pink Floyd song Us and Them with the words, "forward he cried from the rear and the front rank died", is particularly relevant to the Irish health sector.
The recent revelations about top-up payments to senior executives of voluntary hospitals, and four chief executives of these hospitals writing letters about how the latest cuts in health budgets will affect services, epitomises an ingrained mind-set of “us and them”.
Prof John Crown, consultant oncologist at St Vincent's Hospital, remarked on how extraordinary it was to hear those from "the other [management] side" admitting how cuts are affecting patients, as usually only clinicians speak out.
Liam Doran, general secretary of the Irish Nurses and Midwives Association, speaking about the top-up salaries in the voluntary hospitals, referred to "parallel universes" and the sense of "detachment and separation" felt by front-line staff.
Unfortunately, parallel universes are not confined to voluntary hospitals. They existed in 1975 when I began working for the Western Health Board. They persisted and increased in number during the early days of the HSE.
Today they exist everywhere in the health sector despite all health reforms. Parallel universes are characterised by an “us and them” mindset that is deeply ingrained and negatively affects every aspect of healthcare delivery.
It divides the population into public and private. It divides hospitals into voluntary and statutory entities. Community services are another entity. The HSE unnecessarily categorises doctors, nurses and dentists into separate professional groups and all other HSE staff as “health and social care professionals” or “support staff”.
Us-and-them attitudes
This adds to us-and-them attitudes. The mindset divides unions and management, clinicians and management, and clinical and non-clinical staff. Junior managers blame middle managers who in turn accuse senior management of being at fault. We have a completely dysfunctional health system.
Every report on the functioning of various health services published in the past 20 years show that teamwork and joined-up thinking are almost non-existent. Sure, there is a certain amount of multi-disciplinary working but all too often multi-disciplinary practice means several, usually too many, professionals calling to citizens’ houses and hospital bedsides, each delivering their own bit of expertise like ships that pass in the night.
Parallel universes mean that managers of each hospital and service do their own business plans with little input from the public or links to other services.
Fine Gael counsellor Ruairí McGinley, a member of the board of our Lady's Hospital, Crumlin, when interviewed on Morning Ireland last week, said, "It is the company that runs the hospital, not the HSE or the Minister and the HSE has to respect that." Is he forgetting that the hospital received €122 million from the HSE in 2013?
The chief executive of Crumlin hospital signed the letter complaining about how any new cuts would affect services, as did the chief executives of St James’s (€312 million), the Mater (€216 million) and Tallaght (€174 million) hospitals.
Voluntary hospitals
They do not seem to realise that these hospitals are as much part of the system as HSE hospitals, whether they call themselves voluntary or not. In practice, the word voluntary in the Irish health context means just give us the money and we will decide what to do with it.
The HSE 2012 Annual Report shows that an astonishing 661 voluntary and other “outside agencies” received €3.4 billion in funding last year. Voluntary hospitals are included in the same part of the report as organisations such as Muintir na Tíre (€135,000) and the Migraine Association of Ireland (€138,000).
These “outside agencies”, including the 17 voluntary hospitals, operate as separate entities, often in competition with each other.
What is the other side? Surely everyone, whether statutory or voluntary, management or clinical, should be on the citizens’ side?
That is the only meaningful side. Non-statutory organisations deliver good value for money and bring a fresh perspective with citizen involvement.
What matters is that all organisations funded by the HSE see themselves as part of one system and can clearly identify their own role in that system.
Voluntary hospitals must be part of the solution to HSE funding challenges. It is not good enough for any of the 661 voluntary agencies funded by the taxpayer, including the 17 voluntary hospitals, to complain about “them” making necessary cuts.
They need to recognise they are part of one system. HSE managers and professionals also need to see outside agencies as part of the system and not thorns in the side.
Dr Jacky Jones is a former HSE regional manager of health promotion.
drjackyjones@gmail.com