In his new book, Brendan Drumm writes that there are no quick-fix solutions for the health service
It is fair to say that the HSE doesn’t have the best reputation. A measure of its standing can be ascertained by the Government’s decision to disband the entire organisation in the next few years. Speaking to the recent IMO NCHD meeting, National Director of Risk Quality and Clinical Care, Dr Philip Crowley, said that the Executive doesn’t get enough credit for the good work it does. This was a point that former HSE CEO Prof Brendan Drumm used to often make, and it is one he makes again in his new book, The Challenge of Change, extracts of which are exclusively contained in this issue of IMN. Given Health Minister James Reilly’s intention to abolish the HSE in the near future and establish a system of universal health insurance, the publication of the book is a timely reminder of how difficult achieving organisational change in the delivery of healthcare can be.
Some commentators have recently expressed doubt about the Government’s health reform programme, saying that it may do more harm than good in the short term. One of the charges that critics of the new health reform programme make is that the timeline to establish a universal health insurance system is unrealistic. The HSE is an organisation that was established in a very short period of time. In his book, while Prof Drumm does express sympathy with the then Government’s decision to move rapidly, he admits that the HSE faced significant risks related to “the rapidity with which all of the old structures were disbanded and the new organisation established”. The Executive is still living with the legacy of the speed of this transition and the challenge of amalgamating the health boards and other bodies into a single entity. Prof Drumm honestly admits that in the beginning “nobody had any idea how this organisation was really going to get up and running”.
He then makes a spirited defence of the achievements of the HSE’s “transformation programme” (and he is not shy about outlining his part in it) in moving away from a traditional emphasis on hospital beds towards an integrated care model, with more of a reliance on primary care and clinical leadership. Whether this reform was as radical as Prof Drumm clearly thinks, particularly given the slow pace of implementing the primary care strategy, is open to some doubt. However, he strongly contends that the health service is moving in the right direction. Curiously he is silent about the Government’s plan to reform the health system again by winding down the HSE and setting up individual hospital trusts. He does say that changing to integrated care will require a radical change for many countries in the way they fund healthcare, and that the introduction of a national insurance system (which he does not advocate) would promote reconfiguration by paying hospitals based on activity.
A point that Prof Drumm reiterates throughout the book is that reform is a slow process, with no quickfix solutions. In doing so, he seems to suggest that the HSE has been judged too hastily given that it was only established in 2005. It is a point that Minister James Reilly should bear in mind before embarking on his own change programme. Whatever your opinion of Prof Drumm or the HSE, The Challenge of Change is a unique account of the inner workings of the Irish health system and of a controversial organisation that has rarely been out of the headlines since its inception.
