Those in the health service who are unwilling to divest themselves of bad habits can expect a tough response from its newly appointed chief, writes Muiris Houston, Medical Correspondent.
The appointment of Prof Aidan Halligan as the first chief executive officer of the newly created Health Service Executive is highly significant. With just over three months to go before the HSE formally takes over the running of the health system, his appointment gives health service reform a much-needed boost.
Aidan Halligan has had a remarkable career since graduating from Trinity College Dublin in 1984. He chose to specialise in obstetrics and gynaecology. He completed post-graduate training in the speciality in Dublin's Rotunda Hospital and in the Leicester Royal Infirmary.
Appointed senior lecturer and honorary consultant at the University of Leicester and Leicester Royal Infirmary in 1994, he became professor of foetal maternal medicine at the university in 1997 and head of obstetric services at the hospital a year later. Within obstetrics, his particular research interest is in the area of blood pressure disorders in pregnancy.
Significantly, while head of obstetric services, Prof Halligan led the reconfiguration of maternity services at Leicester's university hospitals as part of the implementation of clinical governance. He subsequently presented the results of his work to Prof Liam Donaldson, the chief medical officer, and Sir Alan Langlands, the then National Health Service CEO.
Within twelve months, he had been head-hunted as director of clinical governance for the NHS and head of the NHS Clinical Governance Support Team (CGST).
It is Aidan Halligan's work in this area that will most affect the health service here. As head of a 12-man team, he went to the front line himself, and so he is very aware of the problems that exist at the coalface. He has probably seen most of the evasion tactics employed by those who are resistant to change, and it is this depth of knowledge that should allow him to get an early grip on the reform agenda. Clinical governance is central to the kind of change undergone by the NHS, as well as a key challenge facing the health service here.
Prof Niamh Brennan and her fellow members of the Commission on Financial Management and Control Systems in the Health Service identified the lack of governance as a major deficit in our health service. The commission report stated: "It is important to codify and clarify precisely what governance in a healthcare environment means."
Aidan Halligan has clearly defined his vision of clinical governance: "It is about patient-centred, staff-owned delivery of a quality health service," he says. It is "doing the right thing at the right time to the right person".
In an interview with The Irish Times in 2001, Prof Halligan defined clinical governance as: "The patient-centred delivery of an accountable health service that is safe and of high quality. It is also important that care is delivered in an open and questioning environment".
At a time when the CGST had enrolled over 300 hospitals and trusts into its programme, his patient focus was also clear: "Every patient is the only patient" and "users are the only arbiters of the health system" were typical quotes.
But he was also aware of the staff agenda, pointing out that staff needed to feel valued and empowered. And Prof Halligan also recognised the importance of information technology and systems awareness.
A five-day action-orientated programme - spread over nine months - is the vehicle for change used by the CGST. Aimed at "unpacking" and mapping the process of care, it teaches front-line health professionals how to rebuild the care process with maximum input from patients and on the basis of best evidence-based practice.
An example of how the initiative works is the care of stroke patients at the Royal Bournemouth and Christchurch Hospitals NHS Trust. The challenge facing the support team was that each of the trust's sites had a different way of treating the condition, which was leading to concerns that some patients were receiving a poorer standard of care.
Since the support team organised a programme for multi-disciplinary teams from the hospitals, the trust has implemented a single policy for treating the condition. Patients with stroke are now admitted to hospital rapidly and specialist treatment begins more quickly.
Prof Halligan was also responsible, along with his colleague Dr John Oldham, for tackling the problem of lengthy waiting times for patients to see a GP in Britain. The Advanced Access Programme helped practices make relatively minor but important changes in how they worked so that a hidden capacity in the primary care system opened up to the benefit of both patients and care-givers.
A comment on the NHS reforms by Prof Halligan that will encourage healthcare staff who are wondering what the new CEO's style is like, is: "Once we liberate people's thinking and ability to perform, we find natural leaders emerge who can enthuse staff and develop local implementations."
Passion and energy are two of his most obvious characteristics. People speak of his charismatic approach to reform and those who knew him in his student days say he has developed a certain aura since he moved to Britain. He is an excellent communicator. But there is also a thoughtfulness and certainty, and a gloved steeliness about the Republic's first health service CEO.
Writing in the British Medical Journal about implementing clinical governance, Prof Halligan said of the poor leadership uncovered by the UK Commission for Health Improvement: "There were cliques and factions among groups of staff, management was ineffective, staff with concerns about standards of care were marginalised or worse, adequate systems were not put in place, and the service was not seen through the patients' eyes."
A good description of the more dysfunctional parts of our health service, many observers would say. And while Prof Halligan may speak of winning hearts and minds and bringing people with him, expect a tough approach to those unwilling to divest themselves of years of bad habits.
While proper clinical governance is one of our health service's greatest needs and one of Aidan Halligan's proven strengths, he has more than just one string to his bow. Retaining the directorship of clinical governance for the NHS, he was appointed deputy chief medical officer for England in January 2003. This year, he became director general for clinical strategy and development for the national programme for IT, and senior responsible owner for benefits realisation for the same programme. He also took on responsibility for the implementation of the Modernising Medical Careers initiative.
As deputy chief medical officer, Prof Halligan was the departmental sponsor for the national Patient Safety Agency and the National Institute for Clinical Excellence, responsibilities that reflect his ongoing concern for patient welfare.
A National Audit Office 2003 progress report which looked at the implementation of clinical governance in the NHS noted that clinical quality issues were now part of the UK health service's mainstream. "The machinery, the structures and organisational arrangements to make clinical governance happen are in place", and "clinical governance is well established and embedded in the corporate systems of virtually all trusts", it said.
Crucially, it found that there had been an improvement in the degree of staff and patient involvement in decision-making and that clinicians and managers were more explicitly accountable for clinical performance.
In other words, Aidan Halligan, as director of clinical governance and deputy chief medical officer, has delivered. Not alone has he talked the talk, but he has walked the walk. It is this pedigree and level of achievement that make him such an ideal appointment as CEO of the Health Service Executive.
The 47-year-old married father of three is returning home to a massive challenge. It is inthe interest of everyone - especially of patients and health service staff - that he is successful in his new post.