THE MASTER OF the National Maternity Hospital has said that nurses and doctors are now afraid to work in the Irish health service.
Dr Rhona Mahony said health staff are working long hours, and are fearful of what might happen if things go wrong in the hospital.
We work really long hours and when you are on call and you are in and out of a hospital, wondering what on earth is going to happen. And if you have an adverse outcome how is that going to be treated in the media? How is it going to be treated in the negligence system? And we are losing doctors because I believe people on the frontline are becoming scared to practice medicine in this country.
This is something we really have to grapple with as we will find it hard to recruit people. If we do not support frontline staff we do in turn not support our patients.
Speaking at the MacGill Summer School on finding a solution to Ireland’s “dysfunctional health service”, she said she continues to face difficulties getting approval to hire staff.
“The blunt moratorium on staff recruitment was deeply damaging and to this day it remains extremely difficult to gain approval for medical consultant appointments and other front line staff.”
The head of the Health Service Executive (HSE), Tony O’Brien, said accountability – or the perceived lack of it – is a topic that often portrays the health services in Ireland in a negative light, “especially at times of public outrage following some tragic event”.
He said holding a person to account in the health services when something goes wrong is “fraught with difficulties”.
O’Brien told the audience in Glenties that holding people to account “is not always as simple as many would think”.
“When things go wrong in the health and social care environment, the public demand – and rightly so – that people are held to account if they have transgressed.
“However, being able to hold the appropriate person to account in the health services is fraught with difficulties for a number of reasons – particularly our long-standing and at times quite constraining disciplinary process that we are obliged to follow rigidly,” he said.
HSE disciplinary process
O’Brien said recent High Court decisions concerning very high-profile cases have supported these long-standing processes and have prevented the HSE from circumventing or making changes to the disciplinary processes.
Regardless of the outrage expressed by the public, media and politicians, O’Brien said “long drawn-out disciplinary processes often lead to us being accused of never holding anybody to account”.
“In the absence of ‘a person’ to whom we can readily point to and say – ‘following our disciplinary process we conclude that this person is responsible’ – what happens instead is that those at the very top of the health services become the targets,” he said.
He said that holding the Minister for Health to account for failures in the system was also an issue.
‘Farcical ritual’
“There has been for too long a farcical ritual of the Minister of the day being ‘held accountable’ for every operational-level event or decision made anywhere in the health and social care delivery system even at the most micro level,” he added.
He said this inevitably drives a perverse behaviour among politicians and civil servants who are almost forced to drive an unavoidable top-down, micro-managed approach to management.
“All problems and issues – regardless of how minor – tend to flow upwards to the centre once controversy attaches to them,” he said, adding that this enables a situation where the minister and the director general invariably end up being the only people held accountable by the media or by an Oireachtas committee.
What this actually means is that those whose actually led to the controversy often get to hide in the shadows and are rarely held accountable. It is this faux, ritualistic form of instantaneous knee jerk that serves to undermine real accountability. It is at the heart of the original design of the HSE.
For such reasons, O’Brien said placing the responsibility as close as possible to the delivery of care produces better outcomes.
“With this authority and responsibility devolved to a more local level will come real accountability and the ability to hold the appropriate person or persons to account for their actions or in actions,” said the HSE boss.
Not simple
“It is important to understand that disciplinary processes will always be far from simple,” explained O’Brien.
He said nothing would change until those in charge “grow up, understand the legal constraints that exist in disciplinary processes and overall and view accountability in more realistic terms”.
Despite the title of the debate being Ireland’s “dysfunctional health system”, O’Brien said he disagrees that the entire health system isn’t working.
However, he did admit that the Irish health services construct is “out-dated and not fit for purpose”.
Perhaps making a bid as Budget talks get underway ahead of October, he said if the health service is to be reformed, a significant transitional fund – which lies outside of the normal health budget – is an absolute requirement.
Funding our health service
Funding, or the lack of it, is an issue that is discussed every year when the health budget is announced. Health Minister Simon Harris has said on a number of occasions that last year’s budget was the highest budget to date.
However, the year-on-year increase in demand for services is far outstripping the financial resources provided to supply these services, said O’Brien.
There are other drains on resources, with O’Brien stating that the “outrageous prices charged by some pharmaceutical manufactures for high-tech drugs is eating into our ability to provide other vital services”.
O’Brien also touched on the issue of tragic cases that feature regularly in the media.
He said tragic cases will always exist.
I do not for one second want to trivialise the grief and distress experienced by many families when these cases occur. While we must improve the standards of our services based on lessons learned from individual tragic cases, we should not however, develop policy and the future of world-class services based on these cases. Instead, future health services should be based on the best-available clinical evidence and experience.
He made reference to the recent debacle associated with re-locating the National Maternity Hospital to the St Vincent’s site, a voluntary hospital which up until recently was run by the Sisters of Charity.
Minister Harris has since ordered a formal review to examine the future role of voluntary hospitals, which O’Brien welcomes.
O’Brien said it is important that the governance arrangements within the voluntary hospital sector is regulated.
“While the HSE is the majority funder of all voluntary hospitals – there is an expectation by the Public Accounts Committee and other bodies that we somehow ‘control’ how these hospitals manage their affairs and comply with different Government policies,” concluded O’Brien, who said that isn’t the case.
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