ALTHOUGH THE board of the Health Service Executive (HSE) was specifically protected from collective dismissal under the 2004 Health Act, it clearly did not have the confidence of new Minister for Health James Reilly. Aware in advance that they would be asked to resign in a face-to-face meeting with the Minister yesterday, board members bowed to the inevitable and offered their collective resignation. Each will have been concerned that a decision to resign should not reflect on their professional reputation. Individually, each has offered a personal commitment to the task. However, in its collective performance, the now former board must ask: could we have done better?
With the exception of cancer control, the HSE struggled to achieve substantial reform. But of most concern was its continued failure to introduce the kind of changes that can improve patient safety and ensure a uniformity of care across the health service.
Worryingly, even where deficiencies were well documented, the organisation failed to take sufficient remedial action. Susie Long died unnecessarily of bowel cancer in 2007. Yet, between 2009 and 2010, the HSE allowed the number of people waiting in excess of three months for a colonoscopy – the definitive test for bowel cancer – to rise by 25 per cent. Earlier this month, the HSE’s governance failures were heavily criticised by the Health Information and Quality Authority (HIQA) in a report on an investigation into patient safety concerns at Mallow hospital. It found that system-wide issues identified in a previous report on Ennis hospital had not been addressed at a national level.
The report states: “Given the seriousness of the risks highlighted as part of the Ennis investigation, it is of the utmost concern that the HSE’s corporate and clinical governance systems failed to disseminate effectively learning from an adverse finding by the statutory regulator in one part of its organisation for the benefit of patients across the healthcare system”. It added that this represented a serious failing of corporate governance which potentially placed, and continues to place, patients at risk in some parts of the country.
The HSE’s first chief executive, Prof Brendan Drumm, made the following observation towards the end of his tenure. “The two most important criteria that the public will use to judge our success will be safety and patient experience. Then the only question is: are the public health services safer and are services revolving around my needs?” Based on the health regulator’s recent assessment, the answer to this question continues to be no.
An interim HSE board, to be made up of officials from the Department of Health and the HSE, will be accountable to the Minister for the provision of health services in the State. But in advance of new legislation, both the Minister and his department must effectively resume direct responsibility for the stewardship of public funds and the extent to which key performance targets in the health service will be met. In common with the HSE, Dr Reilly will be judged by his own ability to deliver a safer and better public health system.