Arguably the worst thing about the Health Service Executive report into the harm caused to children by South Kerry Child and Adolescent Mental Health Services (CAMHS) was that it was a direct result of government’s failure to reform the health service.
Given the long waits for diagnosis, treatment and care that are systemic across the Irish public health system; the poor infrastructure including the lack of digitised health records, integrated care and inadequate investment in community services; as well as the absence of clinical and managerial governance and accountability, it is a miracle is that there are not many more scandals unearthed, on a much more frequent basis.
Speaking last week, Taoiseach Micheál Martin acknowledged that what happened to children in South Kerry CAMHS is a failure of governance and accountability in our health system. HSE chief executive Paul Reid acknowledged that the case highlighted “failings in clinical governance and oversight”, that even though concerns about the poor care had been raised since 2018, the risk was not escalated to Community Health Organisation level until 2020 and not to national level until April 2021.
Programme for government
You wouldn’t know from these public statements that Martin and Reid are the very people in positions of most power capable of remedying these faults. The 2020 programme for government stated that “enhanced governance and accountability in the health service is a key component of Sláintecare reform”. Yet it is Martin’s government that is stalling the introduction of clinical and managerial governance and accountability.
Neither the Taoiseach nor the Minister for Health have done much to progress these reforms
The programme for government he agreed also promised to “bring forward detailed proposals on the six new regional health areas to deliver local services for patients that are safe, high quality and fairly distributed”. The regions were the mechanism through which money could be allocated based on population health need, allowing for a fairer distribution of resources. And critically the regions would drive safe and quality care through new fit-for-purpose clinical and managerial governance and accountability structures.
Neither the Taoiseach nor the Minister for Health have done much to progress these reforms, while Reid has articulated his opposition to the regions and has not implemented system-wide clinical governance.
One could argue that these men have been busy managing the consecutive waves of Covid-19, as well as the cyber attack. And they have. In healthcare the urgent usually trumps the important. This was the rationale for a dedicated Sláintecare office to drive reform. The two most senior Sláintecare figures, Laura Magahy and Tom Keane, resigned last September because of the absence of political and institutional (Department of Heath and HSE) support for implementing the regions, eHealth and tackling waiting lists.
Since their resignations there has been little progress on Sláintecare. The Sláintecare implementation office in the department has been dismantled. Magahy has not been replaced. Instead two of Ireland’s highest-paid public servants, Robert Watt, secretary general in the department, and Reid have been charged with Sláintecare’s implementation by Minister for Health Stephen Donnelly. Targets signed off by the Cabinet in the Sláintecare implementation strategy and action plan last May are being missed as there is no reform office or leadership to ensure the plan’s delivery.
We are still not training enough doctors to become clinical leaders across the health system
In a parliamentary question last week, Donnelly said: “Implementation of Sláintecare projects is now devolved to a senior leadership team within my department . . . a new programme board has been established.” This reports to the Minister and is co-chaired by Watt and Reid. The programme board is made up solely of senior members of the HSE and the department and has met once since the senior resignations, a good indicator of the current regime’s top-down, insular approach and absence of priority for reform.
Urgent action
Billions of additional euro and more than 10,000 new staff have been invested in the HSE during the Covid-19 pandemic. Yet we are still not training enough doctors to become clinical leaders across the health system and specifically in child and adolescent mental health. Nor are we training or hiring sufficient numbers of therapists and nurses required to provide multidisciplinary team care. Urgent action must be taken to retain those currently working in the system.
Referring to the damage, mistreatment and harm to children and adolescents in South Kerry, Reid said what happened was “deeply regrettable, beyond comprehension and wrong”. The Taoiseach said it was “shocking, very serious and unacceptable”.
The Taoiseach and Tánaiste Leo Varadkar – both former ministers for health – are, along with Donnelly and Reid, fully aware of the daily risks faced by those who use and work in the public health system due to the toxic combination of years of under-resourcing, ineffective clinical governance and failed attempts at reform. Ultimately, responsibility for catastrophic healthcare failures lies with them.
The response of the health system to Covid-19 is an excellent example of how resources and strong clinical leadership can empower frontline hospital and community initiatives to innovate and deliver quality care at speed to meet people’s needs. It is a real shame that gains made during the pandemic are now being squandered by deferral and inaction by our political and health leaders.
No more scandals, audits and damning reports are needed.
Now is the time to act.