We need tougher regulation and greater transparency

Former health chief, Pat McLoughlin called for tougher regulation of the health services and greater transparency in decision making, when he addressed the HMI Forum in Ardee, writes Maureen Browne.

Tougher regulation of the health services and greater transparency in decision making were called for by Pat McLoughlin, Chief Executive of the Irish Payments Services Organisation, when he addressed the HMI Forum on “Leadership Challenges in a Changing Environment” in the Regional Education Centre, St. Brigid’s Hospital Complex in Ardee, Co. Louth.

Pat McLoughlin
Pat McLoughlin

McLoughlin, who formerly headed up the HSE’s National Hospitals’ Office, was a member of An Bord Snip and chaired the recent local government review, said it was truly amazing that, with the exception of maternity and psychiatric hospitals, it was possible to set up a hospital in Ireland without a licence. It is interesting to look at the implications of applying regulatory proposals for the financial services sector to the health sector.

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“One of our problems is that we don’t have an overall regulatory authority – HIQA does some of the regulating while the Medical Council and the Food Safety Authority are involved in other areas.

“Then there are about 1,000 voluntary organisations working in the health area.  Can we honestly say we are satisfied with their governance?

One of our problems is that we don’t have an overall regulatory authority

“I think we also need to see how decisions are made.  I would like to see how the health service would work if somebody from HIQA sat in on all meetings of the HSE Board and on all risk management committees as will happen in financial services.

Monopoly

“The HSE is a monopoly in that it controls the public market.    If the budget it hands out to a provider is inadequate, services may have to be closed down.”  There is no regulator as exists in other parts of the economy.

He said considerable effort could be put into transformation and the change agenda, while the need to look after business as usual and protect the continuum of services were forgotten.

“I don’t know anybody who would disagree with the idea of centres of excellence but what the public is looking for are centres of competence.  We can’t have a situation where a centre of excellence is announced on Monday and by Friday there are concerns there about queuing, hygiene and MRSA.

“I buy into the transformation package but we need to have an environment and services as least as good as what we are replacing.   Nobody would be queuing up for a dirty hotel and we have to be very careful how we package the transformation agenda.”

I would like to see how the health service would work if somebody from HIQA sat in on all meetings of the HSE Board

He said the HSE had done some things really well.  For example, they handled the Swine Flu very well, there was clarity of roles, journalists were guaranteed briefings and there was a sense that the health authorities were in charge.

McLoughlin, who spent most of his life working in top management in the health services, said he had really enjoyed this part of his working life and found it very sad now to hear people saying they were ashamed to tell people they worked in the HSE.

Disconnect

“There is a disconnect in the system, esprit de corps is needed and we have to get into that space.  Other countries are proud of their health system and we need to get to a point again where staff are proud to say they work in the health service and the public are proud of that service.  JFK used to say that when the Chinese write the word ‘crisis’ it consists of two brush strokes – one for danger and the other for opportunity.”

He said when a new organisation was being established there was a tendency to say everything in the old system was disastrous.  This was an extremely bad approach as what you were saying to the people who were part of that system was that they were the problem.  Not only was the baby being thrown out with the bath water, but there was a problem in admitting that there was ever a baby there at all.

Staff deserved better than to be told the old systems were all bad.  The last thing that was needed was bureaucracy; rather people had to be empowered to make decisions.

Calling for movement between the civil and public service, he said that when the HSE was established, many young CEOs did not want to leave the system,  but it wasn’t possible to move them to other parts of the civil or public service.

He said that as managers moved up the scale they should allow those who came after them to do the jobs which they had formerly done.

He had initially worked in a hotel in the private sector and when he moved to the public sector found he was immediately deskilled, he had a lot less power and less ability to get things done.

Outsourcing

He believed too much importance was attached to management techniques rather than concentrating on knowing and seeing what was going on.  This was what made it easier to manage a hospital than the community; you could go around the hospital and see how the different departments were working.

When he left the HSE four years ago and moved back into the private sector, setting up his own management consultancy he learned the importance of outsourcing whatever was necessary and concentrating on his own core work.

I buy into the transformation package but we need to have an environment and services as least as good as what we are replacing

“In management there are two things you have to do – manage yourself and your time.  You must be ruthless in relation to your own time and the time of people working for you.

“You also need to think, what would success look like for you? – that will help you to establish goals.

“It’s a great mistake for managers to surround themselves with “yes” people.   You need people who are prepared to speak out when they don’t agree with you, who will challenge you.”

Pat McLoughlin formerly worked as National Director of the HSE’s National Hospitals’ Office, Director of Planning and Commission with the Eastern Regional Health Authority, CEO of the Eastern Health Board and the South Eastern Health Board.  He holds a BA and a law degree from UCG and an MPA from Strathclyde Business School.