Will health service be found like Marie Celeste?

Like the ghostly Marie Celeste, the Irish health service could be found drifting, with a depleted crew or no crew at all and people will wonder why this happened, writes Maureen Browne

Anybody interested in seafaring will know about the Marie Celeste. The Marie Celeste was a brigantine vessel which was found drifting in the Atlantic Ocean on December 4, 1872, apparently abandoned by all the crew. The ship was found in sail heading towards the Straits of Gibraltar, it had been at sea for a month and had six months food and water still on board. The crew’s belongings were untouched, there wasn’t a soul left on board and none of the crew, who were all experienced able seaman, were ever seen or heard of again. The tale of the Marie Celeste is one of the great maritime mysteries of all time as it was the archetypal ghost ship when it was found.

Marie Celeste
Marie Celeste. Image source: http://en.wikipedia.org/wiki/File:Mary_Celeste_as_Amazon_in_1861.jpg

You might ask what are the similarities between the health service and Marie Celeste. Not too many, you may say, but on closer examination there are remarkable similarities:

The Crew

The Irish health service has an experienced, able-bodied and capable ‘crew’ or staff. However following more voluntary redundancies and early retirements, their numbers are rapidly depleting. Following the latest mass exodus, and with another 3,300 staff to go by the end of February, the numbers employed in the health service will be back to the early 2000s figure. Interestingly, despite much fewer staff, we see that activity still continues to rise across all main categories. This February will see many front line staff leave and this will certainly have a significant impact on patient services and care provision.

If we continue to shed staff in an unplanned, unsophisticated way we will soon be devoid of many of the skill sets we need to provide the complex web of services required. Politicians have the perfect excuse since the country is being run by Europe and we must reduce costs, as State income is far below current expenditure levels (by some €24 billion). This is a valid reason for reducing costs but it should be done in a more sophisticated, surgical way and in a manner which protects the reliability of the services we must provide.

Interestingly, despite much fewer staff, we see that activity still continues to rise across all main categories

We need to get rid of the blunt instrument of the moratorium and replace it with a more flexible approach to employment numbers. Let hospital CEOs and senior managers manage their budgets and be allowed to fill posts which are critical to their relevant businesses, provided they operate within their budgets. That seems eminently reasonable and immediately does away with all the paperwork associated with attempting to get approval to fill a post which falls vacant. We should agree employment control ceilings related to budget and, in this, as in other areas, let managers manage.  The service is also over managed and hung up on micromanagement and central command which just do not work. It also lacks leadership from the Minister down.

The Drifting Ship

There appears to be no coherent plan for the health service, as the Minister pursues the Holy Grail of universal health insurance. This is, by the Government’s own admission, some years off. But we need an interim plan to get us there, as opposed to death by a thousand cuts. It is laughable to read that the Minister for Health referred back the annual HSE plan to its Board as he was unhappy with it, but for the last six months, the HSE Board has been predominantly made up of Department of Health officials. So where is the joined-up thinking?

It is worrying to think that it is now the end of January and agencies have not yet been given their 2012 budgets, although they have all been put on notice to expect cuts of circa five to six per cent.  Budgets should be allocated at the start of the year and managers allowed manage them over the full year as opposed to clarity coming in March and then trying to telescope financial management or cutbacks into a nine month period to year end.

Let hospital CEOs and senior managers manage their budgets and be allowed to fill posts which are critical to their relevant businesses, provided they operate within their budgets

Notwithstanding our financial woes, we do need a plan, and a coherent one at that. Politically it might have been acceptable to kill off the HSE some months ago but to half do the deed and then put it on life support, until the time comes to turn off the machine is unacceptable. It’s no wonder senior HSE management are seen to be leaving at speed. If this continues the ship will be found drifting, rudderless and crewless.

The Minister says there is a plan, so let’s have it, details and all, rather than making announcements when people are still only working on the plan.

The service is also over managed and hung up on micromanagement and central command which just do not work. It also lacks leadership from the Minister down

You may now see the similarities between the health service and the Marie Celeste. The service will be found drifting, with a depleted crew or no crew at all and people will wonder why this happened. They will blame the economy, the banking crisis, a worldwide depression, but overlook the lack of clear, coherent plans for the health service. If you look back over the last 50 years it is clear that the political system has never allowed the health service implement anything fully. Politics and politicians have interfered too much in health care policy and delivery. We need to change this for the future. Health service planning should be based on need and access and services should be provided and resourced to best evidence based practice – not based on same half-baked, half-implemented Irish solution. Evidence based, best practice, clarity, purpose, vision, effectiveness, value for money and measurability should all be keystones upon which our services are built. The health service of the future should be looked on as an investment rather than a cost.

Is there any hope for us?

I believe there is. Despite all of the doom and gloom once people can access the services, the Irish health service continues to perform exceptionally well. Hope for the future must lie with staff and managers (who remain). Over the last decade the health service has been the subject of much negative press and media bashing and has become the whipping boy for politicians, yet public satisfaction with services and staff is exceptionally high once people manage to access services.

Managers all agree that to be a manager in the health service now is not for the faint hearted. They also recognise that they need to be committed and responsive to need if they are to keep our services afloat, in what is a sea of turmoil.