Private sector would not do better managing the Irish health service

HSE CEO, Mr. Paul Reid strongly challenged what he said was the “relentless media commentary” that the private sector would do better than the public sector managing the Irish health service, when he gave the keynote address to the Conference.

Paul Reid, CEO, HSE
Paul Reid, CEO, HSE

“The suggestion that if we could only get a Ryanair model in healthcare it would be much better, is just nonsense.  I spent 30 years working in the  private sector and the ultimate driver in the private sector is the relentless drive for profitability.  The private sector can make decisions about getting out of a service if it doesn’t looks profitable.  This is not an option for the health service or for the public sector.

“I am saying this, as somebody who has worked in the private sector, the non-for-profit sector and the public sector,  I want to speak to you today about the contrasting management challenges I experienced in the three different sectors, during my  career to date.  There are some consistent management themes running through all three. “

In a wide-ranging address, the new CEO spoke about the need for statutory and voluntary health organisations to work together, the agenda set by the new HSE Board, the challenges he saw ahead for health service managers and the need to get the message out to the public about the good work being done in the health services.

“I also want to talk to you about some of the agenda set out by the new HSE Board and by the Minister, in the context of the future of healthcare in Ireland.

“And I want to share with you here today – managers from the acute, social care, HSE, Section 38 and Section 39  services and professional colleges and public and private care providers –  my vision of the challenges facing you as managers and  healthcare professionals and the road map ahead for the health services.”

The CEO said he had begun working for Eircom as an underground cable jointer, later qualifying as a technician and ending up as Executive of the company.  He also worked for three years as a full- time trade union representative.

as an organisation, the HSE is perceived as being a bit at war with some of our key stakeholders and partners.

“One of the benefits I brought to my current post is that I have a good idea how organisations work, having moved from what was a state body when I joined it and which then became a semi state body before being taken over and owned by venture capitalists.    I learned there the first message which I want to give you today  and that is the need for financial discipline, financial governance and eliminating waste.

“I then had the good fortune to spend some time in the non-for-profit, working for 18 months with Trocaire.  This was probably one of the best periods in my life.  I went in to look at governance, people management, finances and general oversight.  Working in a place like Trocaire really grounds you about what is important.  I spent some of the time overseas, in Africa, South America and Asia.  The one thing that jumped out at me was that we had a huge body of the staff, whose own value systems were very aligned with the value systems of the organisation.  Many people make many efforts to introduce values to an organisation.  You can set guidelines and principles, but it is not possible to impose values.

The lesson I learned there was to check your values system.

“I spent about three years in the Department of Public Expenditure and Reform, going in as an Asst. Secretary at a very difficult time for the country.  The economy had collapsed and very difficult choices faced the Government.  It was a privileged time to be that close to Government and to be involved in helping to make recommendations to Government about big decisions.

“Local Government  is a bit like the health sector. There are great people there who roll up their sleeves, and get things done and work very closely with communities.”

We are going to look at everything we are doing at the centre of the HSE, because I want to be sure that everything we are doing is adding value.

Turning to his early experience in the health sector, Mr. Reid said that before he took up his appointment he engaged across a wide range of stakeholders, politicians, trade unions, patients and staff.  He met all top 40 managers, got access to health systems, visited EDs.  “From this I got a really strong sense of the passion for patient care which staff have.

“However, what I also gathered from stakeholders is that as an organisation, the HSE is perceived as being a bit at war with some of our key stakeholders and partners.  That is not what we are about. I thought how strong we could be when we galvanised all those stakeholders to work with us.  I believe it is possible to do this and get the wind behind our backs.

“In terms of my first four months, in addition to seeing the passion and commitment to patient care, I have got wonderful support from staff and fantastic engagement everywhere I have gone.  People have come to me and said we want you to succeed.  I have never worked in a sector where I felt this as strongly.”

The CEO said he was convinced the health services had to strengthen financial management processes across the organisations.  “It is not a criticism of people or systems, but we have big responsibilities.  We have a €17 bn operational and capital budget and with that goes accountability. I am convinced we can be stronger and better in financial management

“We need to strengthen the connection between national HSE and big service delivery organisations, whether HSE or those funded by the HSE.  We are going to look at everything we are doing at the centre of the HSE, because I want to be sure that everything we are doing is adding value.  If it is not, it is destroying value and we cannot do that, using public funds.

I, as a public servant do not have the legal right to spend beyond what is allocated to us by Government.

“I also want to strengthen our engagement with the clinical workforce.  I  want to make sure we are listening to and acting on the key voice of clinicians. Theirs is an important voice.  I have met all the Clinical Directors.  I can also say on record here that I accept that the issue of pay and pay parity for consultants has to be addressed.  Firstly, it is an equity issue, secondly it is an issue in terms of recruitment and thirdly it is an issue in terms of retention. I do not believe it is a silver bullet, which  will address all our problems.  The Minister is committed to a process in the coming months.  I want clinicians to be working with us.  It is fair enough for them to challenge us, but they are very important from my perspective.  It is very impactful to have a large body of clinicians criticising us and I want them working with us.”

Turning to communications, the CEO said, “We really have a big challenge in the HSE  to get our story out better and this is not just a national but a local issue, because what you do locally is sometimes more powerful than what you do nationally.  We are heading into an election and health becomes very political in an election.  We have to have a road-map  to communicate all the really good stories in health – people are living longer, they are healthier, they are receiving amazing new treatments and I believe the public want to hear this.  We need a new communications strategy and plan so we can show our commitment to patients and society.

“We have a new Board in place since the end of June, with a very strong reputable chair and a membership strongly representative of patient safety  and governance.  It is a very  challenging Board.

“The Board has set out three key objectives – patient safety and patient care, building the trust and confidence of all our stakeholders and the public in the HSE and financial management.

Performance Management is a really strong challenge for the organisation

“We have to manage within our budget this year.  That is a very clear directive from Government and I, as a public servant do not have the legal right to spend beyond what is allocated to us by Government.  I do not have the framework to keep spending.  This is a very real management  challenge for us on which we must work  together.

“We are progressing with Slaintecare and new regional structure.  Slaintecare has got a very good buy-in from the Oireachtas, but apart from the structural element, we want to see integration – from the patients’ perspective it must ‘handover,’ not ‘hands off.’   We can’t be waiting for the next move to the regional structures to galvanise our workforce to build up and scale up good practice.  Locally and nationally,  we must look at best practice and ensure our workforce is connected with the Slaintecare agenda.

“We must also look at how we move to a regional structure.  There is genuine concern about the hospital groupings which will be affiliated to the regions and these are issues that we will be working on for the next nine months and then need we will look for Government backing.”

Mr. Reid said that he wanted to set out some of the priorities he was setting with his own executive management team and for the wider management across the organisation.

“Firstly, before we can move on to big inspirational leadership issues there are a couple of strong management challenges we need to get right,  I think people want to see a good transparent Performance Management plan in place.  There are pockets of good performance management across the health service, but we are not strong in having very good applied performance management across the system  This is about how we value, connect with and give feedback to staff, how we recognise performers and challenge non- performers.  Performance Management is a really strong challenge for the organisation.

Secondly, financial management is one of the challenges i have experienced in my first four months.

“I really need management to own the challenges we have.  When we strengthen controls we will be in much stronger position to discuss with Government what we need to develop our services.”

“The other areas of challenge I would set out for you are that of connecting and engaging with our staff in very open and honest manner and giving them hope and inspiration for the  future. Our staff survey showed that staff are very motivated about the job they do.  but are not feeling a connection with leadership.  Most people connect with their local managers for direction and leadership, so collectively we have a real challenge to galvanise our workforce. One of the best ways to galvanise staff is to get public communications out there,  but you can’ t beat the role of line manager engaging with staff.  i want us all to raise the bar when connecting with staff.”

The CEO said that he had great confidence about where we could bring the health service over the coming years. “We have a good engagement from the Oireachtas, we  all agree about the need for regional structures,  we can galvanise all forces so that we are all pointing in the same direction and we will have a very strong system  I believe we can do this.

“I think there is a willingness to look at budgets differently and in a more integrated way. Notwithstanding the demographic changes where we have a much older age profile in our EDs, our admissions going up, I want us to give a level of predictability to our outturns  We got €2bn uplift in one year and we haven’t got another €2bn this year.  We must look at everything we do –  procurements, legal fees, State Claims Agency fees policy issues around drug reimbursements, biosimilars.

“I want to see how we can implement the recommendations for the voluntaries in Catherine Day’s report. We need to scale up initiatives to relieve  pressure on  the acutes  and we have to get away from the idea that  the natural route to the  health services is through the  front door of and acute hospital.”