THE DEPARTMENT of Health held high-level discussions about the future of the Health Service Executive (HSE) prior to the publication of three reports into the Portlaoise breast cancer debacle, it has emerged.
The Irish Timesunderstands that consideration was given to a radical restructuring of the struggling national health authority that would have involved at least a partial return to the regionalisation of health services in the State. However, a significant restructuring has now been ruled out, with the emphasis to be placed instead on overhauling work processes within the HSE.
A number of sources have confirmed that, such is the level of concern about mismanagement and governance issues in the health service, senior officials in the Department of Health examined the possibility of breaking the HSE into smaller management units analogous to the old health board structures. But this was rejected on the basis that the time-scale needed to restructure the organisation significantly was too great. A strategy of seeking to implement a series of short-term gains in specific projects is to be pursued instead.
Meanwhile, the HSE has itself brought in management consultants McKinsey to work with senior executives in the organisation.
Last week's report by John Fitzgerald, the former Dublin city manager, into the HSE's management of missed cancers at Portlaoise hospital, identified a number of key deficiencies.
According to Mr Fitzgerald, "there was a fundamental weakness in the management and governance of this process from the outset".
He specifically criticised the lack of terms of reference and protocols for the review process.
Mr Fitzgerald's report has crystallised concerns within the Department of Health and the health service generally that similar governance deficiencies exist right across the HSE. Decision-making has almost ceased at a local and regional level, with a direct effect on front-line patient services.
Describing the HSE as "a ship perilously close to the rocks", a senior source last night said: "Decision-making ability is indirectly proportional to the number of managers involved".
Further evidence of high-level concern about the HSE was contained in the response of Minister for Health Mary Harney to the Portlaoise reports.
"I have asked the board [ of the HSE] to consider whether the lessons arising from the systemic weaknesses of governance and management which have been identified in relation to the events at Portlaoise have wider applications across the HSE," she said.
Ms Harney added: "I have also asked the secretary general of my department, in consultation with the chief medical officer, to review and strengthen the procedures in place within the department to deal with clinical safety issues, with a view to ensuring that a clinical perspective is brought to these at all stages".