Members of the Oireachtas health committee have questioned the level of commitment to Sláintecare reforms and the understanding of them at senior level in the HSE and the Department of Health.
During fractious exchanges on Wednesday, the secretary general of the department, Robert Watt, and HSE chief executive Paul Reid told the committee they are committed to implementing the ambitious programme of reforms, including a plan to switch to a regionalised approach to health service provision.
However, members criticised the pair over an email exchange, obtained by Sinn Féin health spokesman David Cullinane, which discussed how implementation of the regional health areas (RHAs) would have to be delayed due to pressures associated with Covid.
During the email exchange, Mr Watt wrote to his HSE counterpart that “structural changes need to be kept to a minimum” with “all corporate functions, clinical care pathways work, etc, would remain the remit of the HSE as they currently are.
“And there would be no vertical reorganisation”. Mr Cullinane said his “heart sank” at reading the email, suggesting that it means power will be “kept in the centre”.
"It doesn't chime at all with what Sláintecare promised," the Sinn Féin TD for Waterford said.
Mr Watt disputed the characterisation of the email, but said it should have been phrased better, and that there was a focus on “horizontal” changes, including “integration at regional level”.
Misunderstanding
Social Democrats co-leader Roisin Shortall raised the same email – particularly a passage which discussed "expanding the remit of hospital groups to include community services". She argued that this betrayed a misunderstanding of Sláintecare, which will see hospital groups replaced by regionalised structures.
“All the indications are that you are seeking to rework Government policy,” she told Mr Watt. The pair had a heated exchange over the matter, with Ms Shortall asking the secretary general to “stick to the question I asked you”, to which he replied: “I’m literally about to answer the question, you don’t get to ask the questions and answer them”.
Ms Shortall later asked: “Do you understand what’s contained in the Sláintecare recommendations” and said that she had come to the conclusion Mr Watt didn’t “get” Sláintecare and did not have “any understanding of regionalisation structures”. He responded that there had been a “complete mischaracterisation” of his email, and that he was not being allowed to answer questions without interruption.
Dr Muiris O’Connor later said the emphasis on the email was “overplayed and isn’t consistent with the work programme under way”.
Fine Gael Senator Martin Conway criticised Mr Watt for the "combative nature of your answers", and said he was "concerned you don't understand Sláintecare in the same way we understand Sláintecare", and that in turn raised issues about Minister for Health Stephen Donnelly's understanding of Sláintecare. Mr Watt said of his combative nature: "That's a trait, you love it or hate it, there's nothing I can do about that," and that he would defend himself if his professionalism and motivations were questioned.
Mr Watt said the Sláintecare oversight board – the new structure governing implementation of the plan – has met twice, and will be reviewed for its effectiveness in the middle of the year. The new board replaced the Sláintecare implementation board, many members of which had resigned, including Laura Magahy and its chair, Prof Tom Keane. It is chaired jointly by the two men.
He said a memo for Government was being drafted on the funding and governance of Sláintecare, which is to be brought to Cabinet in the next few weeks. The committee heard that there will be 1.5 million people added to waiting lists this year, but that the HSE is planning the largest level of service delivery ever which will lead to a significant reduction in lists overall. A plan for waiting lists is due to be brought to Government next week, the committee was told.
Recruitment
Following revelations in last weekend’s Business Post newspaper on what were described as “fake targets” in healthcare recruitment, based on leaked secret recordings of conversations between department officials, Mr Watt agreed that hitting a target of 10,000 new hires will be “very, very difficult” to reach.
The minimum target is now for 5,500 new hires, and the original target of 10,000 is a “stretch target”, he said, adding that it is open to the Minister to ask the HSE to reallocate budget elsewhere if the targets are not going to be hit. The committee heard that there have been a net 12,500 people hired into the health service since 2020, the largest two-year expansion in its workforce since it was established.
Mr Reid said the recruitment targets were being hampered by a jobs market that is “under huge stress”.
Building on information disclosed in the leaked tapes, Mr Reid said he expected there would be a financial adjustment to the HSE’s annual accounts – known as a prior year adjustment – of between €50 million and €100 million.
The salaries of the two men, which have both been the topic of much commentary, were also discussed. Solidarity-PBP TD Gino Kenny asked if they could justify their “colossal” combined salaries of more than €700,000, equivalent to the wages of 18 nurses.
Mr Reid said the salary was designed for a public competition, not for him. Mr Watt said he had no contribution to make. Later, Clare TD Cathal Crowe asked if either man accepted their wages were in breach of recession-era wage controls, known as the FEMPI legislation.
Mr Reid said a long-awaited integrated financial management system was being worked on, and that there were issues, but it would cover 80 per cent of spending in the health service by 2025.
