As he steps down as head of the HSE, Prof Brendan Drumm talks about his achievements, frustrations and bonuses, and says the cuts he has overseen should not affect patients, writes EITHNE DONNELLANHealth Correspondent
WITH ALL his notes on one A4 page, Prof Brendan Drumm relaxes into a leather chair to do one of his final interviews as head of the Health Service Executive. There’s a definite sense of relief in the air – he jokes he still has as much hair now, albeit sparse, as when he started the job five years ago.
That was on August 14th, 2005 when the Leitrim-born professor of paediatrics stepped into the limelight, shedding his cartoon festooned ties and his anonymity to become the first chief executive of the HSE. With him came promises of much needed health service reforms which would make patients’ experiences better and lift morale among the thousands of staff in the health sector.
In the intervening years the news has been dominated by stories of cancer misdiagnoses, patients on trolleys, a recruitment embargo, cutbacks, gaps in child protection services, Ppars (computerised pay system), bureaucracy, bonuses for managers including himself and concerns about the reorganisation of hospital services.
But there was never a day, Drumm claims, when he regretted taking on what many would regard as a nightmare job. Yes, there were sleepless nights, but few; yes, there were some very demanding days which left him exhausted; but “was there any day that I actually turned around and said God I don’t want to do this job, absolutely not”.
He acknowledges there were many incidents which caused the public concern during his term but says the challenge for him was not to let these derail his reform agenda after the abolition of the health boards, and he’s adamant they didn’t.
“In something like a healthcare system the public will always understandably respond to the incidents . . . I mean if one person dies through misadventure, say in a hospital where something wrong has been done to them, that’s a horrendous outcome despite the fact that maybe 100,000 people in that hospital had a good service . . . that’s the environment we have to accept that we work in . . . we tried to fix the incidents but we absolutely kept our focus on the change.”
He insists even if there are still patients on trolleys and some demoralised staff, much did change while he was at the helm of the HSE.
He was involved in the introduction of a new consultant contract, the reorganisation of hospital services in a number of regions, the setting up of a number of primary-care centres and primary-care teams – at a slower pace than might have been anticipated it has to be said – as well as the commencement of a performance management system in the health service. This system provides monthly reports detailing progress on everything from waiting times for urgent colonoscopy referrals, or MRI scans at individual hospitals, to the extent to which each service is adhering to budgets.
However, Drumm believes his greatest legacy will be laying the foundations for an integrated healthcare system, one in which people can get a lot more care in the community and one which clinicians have a say in managing.
His biggest regret though is not getting an IT system in place across the health sector, one in which patients would have a unique patient identifier, and in which all information about them could be accessed whether they were in a hospital, a GP’s surgery or being attended by a public health nurse. Such a system would underpin the running of a much more efficient integrated system.
He’s also disappointed at the progress on outpatient waiting lists which he describes as the biggest bottleneck in the system. There are no official figures for the number of patients on these lists – the ones patients go on when referred by their GP to see a consultant – but a report from the Comptroller and Auditor General last year estimated there were some 175,000 patients awaiting outpatient appointments. Anecdotal reports suggest some are waiting years to be seen.
Drumm stresses, however, that targeted initiatives are now under way to address these waiting times in orthopaedics, dermatology and neurology in particular and believes these should begin to show results quickly.
When Drumm took over as chief executive of the HSE the country was booming. Nonetheless, he says, he was a lone voice in the wilderness arguing we didn’t need more hospital beds or more money to run the health service, insisting things just had to be done differently like treating more patients on a day-case basis and ensuring shorter lengths of stay in hospital for common procedures.
DURING HIS TERMthe boom turned to bust, and this year he's had to run services with a budget which has been cut by more than €1 billion, though about €600 million of this is accounted for by public sector pay cuts. More than 1,000 acute hospital beds will be closed this year and some 1,500 staff are due to be taken out of the health service.
Despite this and all the recent stories of home-help hours being cut, elective surgery being cancelled, respite services being axed and the HSE already running a deficit of €84 million at the end of May, he argues there is no need for any suffering to be inflicted on patients this year if the amount of work the HSE set out in its service plan at the beginning of the year is adhered to.
However, he says it appears activity levels are up. Given the HSE does not have money to finance extra activity the only logical conclusion is that services will have to be curtailed later in the year but Drumm doesn’t actually say this. He says the HSE has managed to provide more activity, that it was paid for last year, and still balance its books.
He admits, though, it will be a challenge for the HSE to achieve additional savings next year on top of the €400 million in efficiencies it’s expected to achieve this year. Confirming that next year up to €700 million may be cut from the health budget he warns there’s only so much that can be saved without hurting services. “We are reaching a point where clearly the savings that we’ve generated become more and more difficult to increase year on year . . . I mean next year we’re told there will be a challenge of €600 to €700 million.”
He signals too that further reorganisation of hospital services is inevitable, partly because of the current shortage of junior doctors.
Put simply, he says, the public can’t be expected to use services in some hospitals which junior doctors won’t even apply to work in. They won’t work there because the jobs on offer won’t give them sufficient experience and training.
Emergency departments in Ennis and Nenagh hospitals for example – which are only open during the day as it is – are now run by agency doctors as junior doctors can’t be found to work in them. His comments could be read as suggesting such units could be forced to close altogether.
“I mean there’s a huge question to be asked there as to how we put the public through a system that our own junior doctors won’t actually take jobs in, so the reconfiguration is absolutely essential to this, but not only reconfiguration, there also needs to be a whole look at what type of doctors we employ. And are there different grades of doctors that we need to employ in hospitals that aren’t just consultants?” he says.
Reform takes time, Drumm stresses, pointing out that what he began was a 15-year change programme. Services were to be standardised across the 10 former health board regions but he says in the area of child protection for example, for which the HSE has been harshly criticised in a number of recent reports from the Health Information and Quality Authority (Hiqa), work on standardisation has commenced but won’t be completed for another two years. “During that time we have to accept that there will be significant areas where performance is not up to scratch,” he admits.
He asserts managers can’t be held accountable for their actions in this area until standardised procedures for all are in place. But when it’s put to him that somebody must be responsible for allowing children to remain with foster families after allegations of abuse are made but before these are investigated – as established by Hiqa – he agrees that “where there has been malpractice on behalf of professionals” it has to be addressed.
During his term the public began to appreciate that not all services could be provided safely in all hospitals, that medical tests are not always 100 per cent accurate and that there are often risks attached to medical interventions. “If we end up in a situation where the public feel that they are absolutely safe within the healthcare system then I think we are misleading them,” he says.
While welcoming the independent audit of health services provided by Hiqa he is dismissive of its recent opinion poll which found over 40 per cent of people felt the healthcare they or their family members received fell below expected standards. He says the way it was carried out was surprising pointing out that the health service itself audits service users, not people on the street who may have read a story about some blunder in the newspaper that morning. Though for the record the Red C poll for Hiqa involved a nationally representative sample of people who were asked about their experiences of healthcare services in general. Previous research carried out for the HSE back in 2007 had found much higher rates of satisfaction among health service users.
NOW AS HE PREPARESto re-enter the world of clinical practice at Our Lady's Hospital for Sick Children in Crumlin and academia at UCD – he wants to carry out research into "reintroducing caring to medicine" – Drumm believes at least some of the criticism of him in office, particularly of him accepting bonuses, was "extremely unfair".
He says his last bonus was €70,000 and that was in respect of 2007 “when Ireland was booming” and it was only “€30,000 after tax or something like that”.
He believes the HSE is extremely transparent, even if some figures – like those for outpatient waiting lists – are not provided by the organisation.
So does the HSE always get it right? “I’m sure we don’t,” he muses.
After his departure Drumm will continue to do all he can to support the building of a new national children’s hospital. The former interim chief executive of Eircom, Cathal Magee, steps into his shoes on September 1st but Drumm is reluctant to offer him any advice.
“I think it’s really important that you get a change of chief executive, that a new person comes in with new ideas. It would be totally wrong for me to actually try and impose things that I think that Cathal should do.”
