The priorities of the new Director General of the HSE

Paul Reid, the new HSE Director General says his three priorities for healthcare are the delivery of quality and safe services, transitioning to a new model of integrated care and strengthening confidence and trust in the organisation. Maureen Browne reports.

Paul Reid
Paul Reid

“I want to ensure care and safety for all patients and users of the service, that we move to a new model of care as part of the overall Sláintecare reform programme and that we build trust and confidence with all HSE staff, stakeholders, partners, voluntary organisations and the various professions.”

Mr. Reid said that apart from the need for the HSE to break even this year, he would rank progress on these three priority areas as a mark of “success” for the HSE at the end of 2019.
The DG has a given a stark warning to all senior managers on the need to manage and control spend within their budgets.

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He said that meant managing risks proactively and effectively, as close as practical to the level at which they arose. The health service would no longer spend money it did not have and breaching budgets would not be an option.

He told senior managers that the HSE must come in on budget in 2019 and they needed to review their expenditure to ensure that they met this target, If demands led to incurring further costs in an area, they should look at cutting back on lower priority services.
“I will consider it an absolute failure of management, and of individual managers, if the primary net effect of good disciplines of financial management is that multiple problems and risks are simply transferred upwards to the next layer of management and ultimately arrive at my desk,” he said.

Apart from the need for the HSE to break even this year, he would rank progress on these three priority areas as a mark of “success” for the HSE at the end of 2019.

Mr. Reid said he was very glad to have joined the HSE. “It is a very privileged role. I have always been partial to the public services and there is no greater place to be in the public sector than in the health service, where we have the opportunities to make people’s lives better.

“I know our staff and management are committed to patient care and there is a huge value in the various partnerships we have in the services.

“I have a background in health –with Minister Helen McEntee, I co- chaired the National Taskforce on Youth Mental Health, I was a member of the Sláintecare Advisory Board since 2018 and I had a lot of engagement with health in my role as Chief Executive of Fingal County Council during the last five years.”
The new DG also said the executive needed to clearly communicate “the reality that there was no recruitment embargo or moratorium in the health service nor was there a ban on agency or overtime.”
He said that by agreement with the Minister, the HSE was extending the review of the Winter Planning Process in 2018/2019. to include commissioning an Independent Expert Group to carry out a review of ED Performance and Activity Analysis over the winter period in nine individual Hospital Focus Sites and their associated CHO Areas.
The Expert Group would examine ED performance but would have regard to capacity, bed utilisation and internal capability including consultant manpower and medical / nursing and AHP staffing levels.

The executive needed to clearly communicate “the reality that there was no recruitment embargo or moratorium in the health service nor was there a ban on agency or overtime.

Asked about the timeline for the new Regional Integrated Community Organisations (RICOs), the DG said this was a major element of Sláintecare, which was a ten year reform programme. “There is a considerable amount of analysis to do in terms of how best to construct the organisations based on population and in the first instance the Government has to approve in principle the numbers of integrated organisations around country. It is obviously up to the Minister to say when this will happen, but we hope it will be soon.

“I would expect that a lot of the work will be going on through the Department of Health and the Sláintecare office in conjunction with ourselves.

“I hugely value the move toward integrated care organisations, as it represents the community and the acute sectors working together. I am three weeks now in the job (on the date of our interview) and I have already visited Tullamore, Mullingar and Galway acute and community services and the CAMHS services and I see the need nationally to move towards more integrated care. The acute sector is under severe pressure because of the way service users and patients, who could be better supported in a community environment, are part of the acute service. And again, we don’t have full capacity in the community.

Asked if Sláintecare would be just another layer of management, the DG said if that happened, we would have failed.

“If that happens, we have failed. It is not more management we need but more integrated processes and to build capacity in the community in terms of diagnostic support care. Sláintecare is about a more devolved integrated patient experience, the right management and devolving functional management and budgetary decision making to integrated care level.

Mr. Reid said future funding models would depend on processes that were being evaluated in terms of determining population-based health models, the various demographic spreads and the kind of illnesses etc that would be treated in the various sectors. However, in principle, funding models would be more devolved with more local accountability.

The D.G. said the digital strategy was a major element of the capital programme. “I have worked on digital strategies throughout my careers in various sectors. They are generally 5-10 year strategies. In the health area, the major elements of the digital strategy are Electronic Health Records, Individual Health Identifiers and digital imaging. “The complexity of the HSE, with its multi-sites, makes the digital strategy imperative. There are big transformations underway, but we are starting from a low base. The new Children’s Hospital is the first major centre where technology will be fully deployed, but we will be introducing digital programmes at various intervals over the next ten years.

Asked if he thought more beds were required in the system and if so, whether these should be acute, step down, rehab, or respite, Mr. Reid said an additional 2,600 beds were going to be provided over the next ten years. “We probably need more acute beds first, as we are extremely pressurised in the acute sector, but we also need to make an investment in step-down community beds. I saw some great examples in Galway of how community beds could be used. In Galway, they are carrying out some elective treatments in the community setting which is taking pressure from the acute sector. Again, this is all about investment in new and not just current models.

We probably need more acute beds first, as we are extremely pressurised in the acute sector, but we also need to make an investment in step-down community beds.

Queried as to whether the Children’s Hospital overrun would result in approved capital projects being deferred, Mr. Reid said he did not expect this would happen.

“I think the nature of the capital programmes (and I have worked on capital projects for many years) is that they are three, five and ten year programmes. In that period, some emerge and some drop off, which means there is more flexibility in capital expenditure than in current expenditure. I am quite hopeful that we will meet
all our current requirements in terms of funding, but we are still going through the process.

Asked about the Independent Review Group on the voluntary hospitals and their future role in healthcare delivery, Mr. Reid said that was good information in terms of the role the voluntary hospitals played and their huge value to the health services. “I want to strengthen the relationship between the voluntary hospitals and the HSE. We also need to invest in the voluntary sector. They are a major provider of health care in Ireland and as such are hugely valued.”

Mr. Reid said he would like to get more of the successes of the Irish healthcare out into the public arena. “From visiting hospitals and the community, I saw there are great services being provided, and indeed integrated care delivered, but we don’t always manage to get these positive messages out. The National Patient Experience Survey has had a very good take-up by patients and we have had some very good feedback. We need to celebrate the good initiatives in the service and the successes of our staff and the partners who work with us.”

A native of Dublin, Paul Reid worked as Chief Operations Officer in the Department of Public Expenditure and Reform and an Executive Director with eir before joining Fingal County Council.