According to the HSE website:
“The establishment (in 2004) of the HSE represents the beginning of the largest programme of change ever undertaken in the Irish public service.
Prior to this, services were delivered through a complex structure of ten regional Health Boards, the Eastern Regional Health Authority and a number of other different agencies and organisations. The HSE replaces all of these organisations.
It is now the single body responsible for ensuring that everybody can access cost effective and consistently high quality health and personal social services. The service will be delivered making best use of resources allocated by Government. The largest employer in the State, the HSE employs more than 65,000 staff in direct employment and a further 35,000 staff are funded by the HSE. The budget of almost €12 billion is the largest of any public sector organisation.”
Oscar Wilde described fox-hunting as “the unspeakable in pursuit of the uneatable”. To paraphrase Wilde, the current HSE/Hospital Consultants dispute is “the unmanageable in pursuit of the unbiddable”.
When the HSE was formed and the multiple regional health boards abolished, there should have been multiple redeployments, early retirements and redundancies among staff of those bodies. In any real business this would have been the inevitable consequence of the merger.
Instead, in the interests of industrial peace, the Government conceded that there would be no redundancies and no forced relocations. The end result must be an organisation with multiple duplications and overlaps, sections with no real function to perform, disgruntled employees who have lost status and career prospects.
The result is that there is probably a substantial “fifth column”, some of it at quite senior level, working within the HSE to undermine the organisation and prove that the new structure is unworkable. This “fifth column” is undoubtedly welcomed and abetted by representatives of the various interest groups who are at odds with the HSE - not just employee groups such as consultants and nurses, but also local hospital support groups.
The Government replicated this flawed approach in its efforts to cover up the complete nonsense that is their 2003 Decentralisation Strategy, happy to waste public service employees and public money to disguise its own incompetence.
The danger now is that, with the next election in sight, the Government will simply try to buy industrial peace in the Health Service by conceding on all fronts, wasting even more public money. If this approach is adopted, it simply digs an even deeper hole into which more money is poured and increases the risk of the whole health service becoming even more dysfunctional.
Footnote: Excluding sections in italics, published as a letter in the Irish Independent. An edited version also appeared in the Irish Examiner on 26th Feb.
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