Why did Aidan Halligan walk away from the health service's top job? Dr Muiris Houston, Medical Correspondent, sifts the theories
It has been a landmark week for the health service. On Monday, The Irish Times reported that Prof Aidan Halligan, the CEO designate of the new Health Service Executive (HSE), would not be taking up the post as planned in January.
Thursday brought the Health Estimates and the first real look at how the Tánaiste and Minister for Health, Mary Harney, would tackle her new brief. And yesterday, the legislation governing the modus operandi of the HSE was published last night.
From January 1st next, responsibility for the day-to-day running of the health service will be transferred to the HSE. Halligan was a key element in ensuring stability at a time of change. His decision to walk away, for family and personal reasons, has left the system in a state of shock.
Not surprisingly, some of the 95,000-plus employees of the public health service wondered aloud what Halligan's "real" reasons were for changing his mind.
One of the first and potentially most plausible theories was that, as CEO of the HSE, he would not hold the purse strings of the health service.
There has been an ongoing tug-of-war between the Department of Health and the board of the HSE as to who would be given the title, in civil service parlance, of "accounting officer". Would it be the new CEO of the HSE or would it remain with the secretary general of the Department of Health?
Early in the week informed sources were adamant that the function would remain with a slimmed-down Department of Health. However, under the legislation published last night, the new CEO of the HSE will clearly control the budget from January 1st, a fact which would seem to rule out theory number one as far as Halligan's decision is concerned.
Another theory was that Halligan was not impressed with the quality of the candidates he was interviewing for the next layer of management below him in the HSE hierarchy.
Although we do not yet know who the successful candidates are, a number of sources said yesterday that Halligan had been satisfied with the outcome of the interviews he had participated in prior to his decision to withdraw. And while we may have to wait and see the final line-up of appointees to divisional directorships within the HSE to fully assess this theory, at this point its credence is questionable.
Was Halligan unhappy with the final shape of HSE legislation?
He was not available for comment yesterday, so it is difficult to analyse this theory without his input. But the indications are that the legislation does not contain any aspects that he would have found truly unpalatable.
He may not have got everything he wanted, but then legislation is more a product of the political process and someone with his experience would know that until a Bill becomes an Act, the detail could, and probably would, change.
Finally, there is what is for many the doomsday theory. Halligan engaged closely with Mary Harney and the interim board of the HSE for five weeks after initially accepting the job. Did he conclude from a close-quarters analysis of the Irish health system that it was essentially unmanageable? Did he feel that he could not bring about the changes that everyone accepts are needed for a patient-centred, staff-owned delivery of a quality health service?
CLEARLY, IF THE answer is yes, it is bound to leave people feeling particularly vulnerable and hopeless. It could well be that this theory reflects more on those who are asking the question from within the health system than it does on the man whom they saw as the "white knight" coming to rescue the Irish health service from abroad.
Are things really so bad that we need to import leadership from abroad? Is the health system fundamentally leaderless? Whatever the answer to these questions, the one fact that will either make or break the reform process is whether there is a deep enough political will to make it happen. Which brings us to Mary Harney and her first Budget as Minister for Health.
The initial signs are good. It contains a number of focused initiatives: a 10-point plan for Accident and Emergency; a new type of medical card offering cover for doctor visits but not for drug bills; and an especially welcome focus on disability, with a commitment to employ 1,000 extra therapists and nurses to deliver front-line services.
The Minister promised us she would target specific problem areas when she took the job. On the evidence of the Estimates, she has lived up to this promise.
However, there are stormy waters ahead as the HSE moves centre stage. Harney must drive the process of change with a strong political hand, otherwise it could easily be blown off course.
As for Halligan, it is clear from his own comments and from those of Kevin Kelly, the chairman of the HSE, that Halligan's family, and especially the educational needs of his teenage daughters, were the real reason he opted out.
People who prioritise family life and who have experience of the needs of teenagers will have little difficulty appreciating the influence of these factors in Halligan's decision.