Vicky Phelan, Emma Mhic Mhathúna and Stephen Teap (husband of Irene) have consistently called for management and political accountability for the health system failings that continue to emerge from the cervical cancer controversy.
Yet politicians from across the spectrum have happily jumped on the accountability bandwagon, rushing to judgment, without taking ownership of their own culpability for the current state of affairs.
Micheál Martin was the health minister who made the decision to create the monolith that is the HSE. Mary Harney oversaw its establishment, despite all the warning signs that they were rushing into it in the wrong way. She and subsequent ministers – James Reilly, Leo Varadkar, Simon Harris – failed to put in place structures and a culture of accountability in the national health system for which they hold ultimate political responsibility.
Early in the 2011 coalition tenure, James Reilly got cabinet approval to dismantle the HSE board, an essential aspect of governance structures. Despite promising to do so, Varadkar and Harris have to date failed to reinstate that board.
Fianna Fáil, Fine Gael, Labour and many Independents have participated in successive governments during the last two decades which have spectacularly avoided much-needed health reform, instead continuing to stagger from crisis to crisis.
Political rhetoric
The most senior officials in the Department of Health also have responsibility for the distinct absence of reform and the continuous, often inept, firefighting which means that many of the tricky issues persist despite never-ending taskforces, supplementary budgets and political rhetoric that promises to deal with the crisis of the day.
Think of the ineptitude of allowing persistently high numbers of very old people on trollies in overcrowded emergency departments, hundreds of thousands of people waiting for a first hospital appointment, thousands of fragile children and young people in urgent need of psychological support who languish on a waiting list for mental health services. When these issues reach a hiatus, much political noise emerges, but little if anything actually changes.
Tony O’Brien took over the HSE at the hardest of times, when the government disproportionately cut the health budget. This resulted in a public health system with fewer staff and less money that was still expected to meet the needs of a growing, sicker, ageing population. O’Brien was handpicked by James Reilly as director general for the biggest organisation in the country that was meant to be disbanded. Reilly’s plan was that the HSE would cease to exist by 2015. Against these odds, under O’Brien’s leadership, more than 100,000 staff continued to care for millions of people every day, often the sickest and poorest.
O'Brien's manner and management speak do him no favours, concealing his genuine commitment to delivering high standards of care and public service. He brought clarity, steely determination and integrity to a role that few could manage, willing to break senior public service convention by openly taking on his political bosses. That said, O'Brien's decision to go on the board of US contraceptive company Evofem Biosciences early this year showed poor judgement on this matter.
Right up to O’Brien’s resignation last Thursday night, politicians were calling for accountability, the very accountability they failed to put in place. It suited politicians, Ministers and senior health officials that O’Brien was focus of a political and media witch-hunt, that it was his head which rolled.
The 2016 HSE memos which emerged at the Public Accounts Committee last Thursday, sent to O'Brien and Department of Health chief medical officer Tony Holohan, among others, expose a senior health management that wanted to defend the screening service (presumably in women's best interest). Critically, they reveal a culture which did not prioritise the interests and needs of the 209 women who had had false negatives. They did not put these patients first. And they uncover a siege mentality that pervades senior health officials in the Department and the HSE.
Women’s health
Speaking at the health committee last week Fine Gael TD Kate O'Connell reacted to O'Brien, saying "this is not about you, it's about the women of Ireland who yet again have been let down by the health service and by you". In the wake of this controversy, politicians from across the political divide might reflect on how successive governments have failed to effectively implement their own women's health strategy. Despite the establishment of a women's and infant health programme and so-called priority given to gynaecological wait times, last month there were 5,026 women waiting more than one year for their first appointment with a gynaecologist.
As long as this Government and future governments continue to just plug holes, the ship that is the public health system will keep on sinking. The time has come to stop the reactive politics and political point scoring and revert to the consensus that brought about Sláintecare – a 10-year plan for whole system health reform – that politicians signed up to a year ago.
Central to Sláintecare is an accountable health system that meets the needs of the Irish population. Politicians should listen carefully to the candour and courage of Phelan, Mhic Mhathúna and Teap. If ever, there was a time for politicians to step up to the mark, deliver health reform, finally prioritising people’s health and wellbeing, that time is now.
- Sara Burke is a health policy analyst in the Centre for Health Policy and Management in Trinity College