A tumultuous 10 days within the health system have added to the general sense of uncertainty surrounding its management and future direction.
Before the Minister for Health, Ms Harney, had even published legislation providing for the establishment of the new Health Service Executive, the organisation had lost its chief executive officer designate, Prof Aidan Halligan, who opted not to take up the post. He has been succeeded on an interim basis by HSE chairman, Mr Kevin Kelly, who must repond to the decision of a significant number of those working in the service, including middle and senior management, to vote to cease co-operating with the HSE from mid-December. And despite soothing noises, industrial action cannot be ruled out.
Such tensions are a reflection of the massive change management process which is taking place. The 11 health boards, which have formed the backbone of health service delivery since 1970, are scheduled to be replaced by the HSE from January 1st. Voluntary hospitals, accustomed to dealing directly with the Department of Health for annual funding, must now line up with other hospitals in their region and deal with a new entity, the HSE's National Hospitals Office. Community and psychiatric services may face the least change but they too must learn to live in a new system.
Prof Halligan would have brought clarity to this process. His experience in managing significant change in the National Health Service in Britain, coupled with his expertise in clinical governance and his commitment to investing in information technology would have reassured many. The question now is: does Mr Kelly, as a former banker, have the same energy, drive and experience to see the process through?
Concerns have been expressed by opposition politicians that the Oireachtas has been given insufficient time to debate the new Health Bill. Certainly, four weeks is a short time to discuss such important legislation. The fear must be that the Bill will be guillotined in the days before the Christmas recess. This would represent a less than auspicious start to the single biggest change in our health system in over 30 years.
Ms Harney has impressed most observers with her first set of Estimates as Minister for Health, but she faces an uphill battle to ensure the targeted changes she has outlined become a front-line reality. Her ten-point plan to deal with the crisis in hospital accident and emergency departments is well thought out. The commitment to provide 1,000 nurses and therapists for the disabled is most welcome. But her real challenge is to ensure these plans make a real difference to patients, in the face of a dysfunctional system already struggling to deal with change.
This is not the time for industrial action in the health service. Change should not be forced through the Oireachtas nor the health system. The Minister, management and workers must proceed firmly and sensitively if patients are to see a better quality health service.