The future role of the Department of Health

The Department of Health was prioritising how to equip itself to contribute to the leadership required to improve health outcomes, Mr. Jim Breslin, the new Secretary General of the Department of Health told the HMI Dublin Mid Leinster Forum.  Maureen Browne reports.

Jim Breslin
Jim Breslin

The Department of Health was prioritising how to equip itself to contribute to the leadership required to improve health outcomes, Mr. Jim Breslin, the new Secretary General of the Department said when he spoke on “Leadership In The Irish Health Services,” at a meeting of the HMI Dublin Mid Leinster Forum in the Dublin Dental Hospital.

He said that people who worked in the health sector were a bit closer to the immediacy of people’s lives because through delivering care, managing health services or writing policy it was possible to impact on people’s lives in a meaningful way. “It’s not just a job and people bring more to it than just coming in to work”.

We are very close to finalising with the Minister on a set of priorities for the new three years.

He also revealed that an immediate organisational development was underway in the Department to clarify its role for the future.

The objective was to clarify the role of the Department for the future, to promote internal staff communications and engagement, to agree and communicate the priorities for 2015 and the following three years, to organise and allocate staff resources, to support staff development and to review and strengthen external relationships.

The Department now had about 350 staff (down by over 180 since 2009) and had to think about its role with the creation of the HSE and the Department of Children and other developments. “This is a foundation piece of work. We are nearly there. We have an outline now and we need to link in with other partners in the health service and beyond to see how we relate to them.”

He said he saw the role of the Department as providing leadership and policy direction for the health sector to improve health outcomes, being responsible for governance and oversight to ensure accountable and high quality services and collaborating to achieve health priorities and contribute to wider social and economic goals. In order to do all of this it was necessary to create an organisational environment where, on an ongoing basis, high performance was achieved and the knowledge and skills of staff were developed.

The day to day delivery of services  is not the business of the Department nor is it the Department’s business to be meddling, but we have a very legitimate oversight role which is played in the public interest.

“We have set out to engage on communications and engagement and to try and embrace the talent that is in the Department. We are very close to finalising with the Minister on a set of priorities for the new three years. The Minister will publicly announce these priorities and commit to them and we will then try and focus on a set of priorities that are realistic and on which we can work very closely with those in the wider health service. We will then look at how staff are organised to deliver these priorities and at the development of staff and try and strengthen our external relationships.

“We have some track record in the Department and I think we can improve on it. The day to day delivery of services is not the business of the Department nor is it the Department’s business to be meddling, but we have a very legitimate oversight role which is played in the public interest and we will be trying to relate to the bodies we fund and those with which we interact.

“I think we need to be much better at collaboration – for example, if we are to enlist the support of other sectors for the Health Ireland agenda – and we need to work on the wider economic agenda.”

Mr. Breslin said that when the HSE was set up, Dr. Aidan Halligan, an Irish doctor who was then working in the UK health services was offered the post of first CEO. “He would have come with a big track record but he chose at the last minute to back out for family reasons. However, at the time in an article titled ‘Is the health system fundamentally leaderless?’ the Irish Times queried if Dr. Halligan backed out because he concluded from a close-quarters analysis of the Irish health system that it was essentially unmanageable. The paper said it could well be that this theory reflected more on those who were asking the question from within the health system than it did on the man whom they saw as the ‘white knight’ coming to rescue the service from abroad.

“I think the idea of a ‘white knight’ still persists to some extent, but should leadership in the Irish health services come from within?”

“I think managers become more valued and are perceived to be more reputable when they leave the Irish health services.

Mr. Breslin said that doctors’ opinions on managers ranged from the idea that they were trying to frustrate doctors and turn them into middle-grade civil servants to the view that there were lots of famous Irish doctors but few famous Irish healthcare managers.

“I think managers become more valued and are perceived to be more reputable when they leave the Irish health services. There is a list of managers who have become very successful when they went on to the private health services or other sectors We seem to find it difficult to recognise them while they are in the public health services.

“We need to move beyond the pursuit of the ‘white knight’. If we all have failings, as we do, and if we can all be characterised as inadequate in our management and leadership perhaps we should stop looking for a ‘white knight’ and we might move on towards something more collective, bringing people currently involved in health together in a collective leadership.”

Mr. Breslin argued that we needed to have an element of balance between the idea that public servants were accountable to their own ideas of public service (which was a really comfortable place to be) and the other extreme where they were so overly hide bound by regulations that they were unable to use their talents and experience to exercise leadership, responsibility and judgment.

He instanced the case of Capt. Chesley Sullenberger who bucked the rules and combined procedures and professionalism to safely land his disabled plane in the Hudson and make sure everyone got out.

“He had developed professionalism over many years and he was able to trust his crew. They made good decisions together and didn’t give up and valued every life on that plane. He was concentrating on the option that might save as many lives as possible. He was fully versed in the aircraft’s instrumentation and knew all the rules but did not follow them on that occasion.

“The challenge for us is not to be pessimistic but to be realistic and hopeful… If ‘white knights’ don’t exist to solve our problems, it falls to ourselves, to the people in this room and the people in the wider health service to give us the collaborative leadership for the benefit of what we all have in common – the care of our patients and the health of the populations.

“I think change is really important but we need to be clear on the benefits of structural change as change is quite disruptive. That is not an opt out of change. We need change but it needs to be proper change, properly articulated and done in a planned fashion.

“I think we are too insular in Ireland and the debate is not sufficiently focussed on health in Ireland versus health in other countries.

“I think we have to have a system that gives the really important essential reassurances to the public around quality and cost. There has to be consistency and equity right across the country. But you can have a system that is totally overloaded with protocols and might tick all the boxes but might not be fundamentally about the care and experience of people when they come to the healthcare services.

“I am in favour of building systematic approaches. You can have the best standards in the world to which everyone has signed off but the real thing that binds you is the common belief and determination to try and get the best out of the system for patients and clients.”

He said he was broadly hopeful that the signal coming from hospital groups and community health organisations was de-centralisation, as previously too much was sucked into the centre. It was to be hoped that in future there would be more decisions making at a lower level and functions would be redesigned to support that. He was very encouraged by the progress made through the National Clinical Programmes in improving the delivery of care and in promoting clinical leadership.

“We had some benefit in earlier years from work done by the Office for Health Management and other initiatives which produced future CEOs, hospital managers and leaders of the health service, who did a huge amount of work, and clinicians and doctors who led over the period. That is an area on which we need to re-focus. It is something which we are prioritising in the Department for our own staff, how to support and up-skill our own people.

“Many people are now joining organisations for their mission and value experience and not simply for the salary. Whatever our manpower and workforce issues are now if we don’t do work in that direction it will create more problems for us.”