This spring sees a changing of the guard in the Irish health service. After three years at the helm of the HSE, Bernard Gloster leaves the role of HSE CEO, having restructured the organisation into one that is more region-centred and productivity-focused.
While he has made some progress on tackling long appointment waiting times and hospital overcrowding, it is clear that more work needs to be done to fully implement Sláintecare and ensure equitable access to healthcare for all.
Step in, Anne O’Connor. An occupational therapist by training, she took on the role of HSE CEO from March 23 after a recent stint as managing director of Vhi Health and Wellbeing.
Ms O’Connor has experience in leadership roles within the health service, having formerly held the position of Chief Operations Officer at the HSE.
That should give her an insight into the task at hand and the challenges that await, which include creaking disability and mental health services and a string of controversies around Children’s Health Ireland. Plans to disband that hospital group next year will see the National Children’s Hospital come under the new HSE head’s remit.
Ahead of her first day in the role, Irish Medical Times asked some of the country’s healthcare leaders and experts one question: ‘What, in your view, is the one key thing the new HSE CEO should do to improve the Irish health service?’
Here are their responses.
Dr Maria O’Kane
“If I were to identify one key priority for the incoming HSE CEO, it would be a commitment to intentional collaboration across the health system, including with regulators. This collaboration should be anchored in our shared priorities – patient safety and public trust.
Ireland’s health service is complex and under continued pressure. In this environment, it’s important for public health organisations to align across a small number of shared outcomes: Safe patient care; supported, competent medical professionals; transparent decision-making; and consistently high quality and standards across the board.
Right-touch regulation plays a key role here. Proportionate, fair, and evidence-informed regulation supports doctors in their practise, while addressing risk where patient safety is concerned. The Medical Council, as the regulator of doctors, is an essential partner in ensuring patient safety and trust.
When we align on these fundamentals, we make stronger decisions. And as a result of this collaboration, the system will become safer for patients and more sustainable for staff.Clear shared priorities, backed by consistent collaboration, are what will move our health service forward. We wish Ms O’Connor the very best in her new role.”
Martin Curley
“Anne O’Connor brings a wealth of experience to the CEO role and will already intuitively know the key levers for improving system performance. My key advice would be to focus on reform of the HSE’s culture.
Peter Drucker said ‘culture eats strategy for breakfast’. Winston Churchhill said ‘However beautiful the strategy, you should occasionally look at the results’. While Slaintecare is a very nice strategy the results very much lag the unprecedented increase in investment Ireland has made in healthcare in the last eight years.
There are so many talented and committed clinicians who have to operate in a culture that is challenging. The culture should move to what I call a 4E Culture: Envision, Enable, Empower to Excel.
The only viable strategy for health system sustainability is a complete digital transformation which builds a new health system which revolves around people and their homes and not hospitals. Digital transformation is a series of deep cohesive cultural, process and technology changes catalysed by technology triggers.
A leapfrog digital strategy aligned around a new theory of ‘Stay Left Shift Left-10x’ which priorities illness over wellness, home over hospital, and partnership over paternalism is what is required. Good luck Anne O’Connor.”
“One of the hardest parts of being HSE CEO is to pay attention to the important, whilst always being distracted by the urgent.
There will always be the high profile, tragic cases that need your attention, the incident that has hit the headlines, the problem the minister wants answers to yesterday.
The job of the CEO is make sure all these matters are managed well, but more importantly to keep their eye on the long-term goal of the health system – to improve population health, to reduce inequities and deliver on health reform.
There is momentum on reform – on providing universal access to timely, quality integrated care. This needs to be harnessed with clinicians, front line personnel, health system managers and administrators, patients, members of the public and communities.
The new CEO needs to build on the effective cross-sectoral and partnership work that has begun, using good evidence to inform health system planning and delivery.
Anne O’Connor, I wish you great success. Remember there is a whole eco-system out there wanting to support you in delivering on your new role. It is in all our interests that we support you to succeed. Best of luck!”
Dr Lorcan Martin
President, the College of Psychiatrists of Ireland
“The one key thing for the new CEO to ensure would be that funding for health services translates into permanent whole-time equivalent posts on the frontline, and that these need to be filled with permanent, appropriately qualified staff and not merely temporary, locum, agency or inadequately trained staff.
It is not enough for funding to be allocated, only for it to disappear when posts are not filled. Additionally, such staff should be valued and when issues or failings arise due to teams not being properly resourced, then management at relevant levels should be accountable.”
Phil Ní Sheaghdha
“It is the view of the INMO that the new Chief Executive Officer of the HSE must make safe nurse and midwife staffing a priority.
The HSE’s Pay and Numbers’ Strategy in its current form means that far too many hospitals and community services are understaffed. Our members report that they constantly find themselves working short.
The new CEO must be a champion of safe nurse and midwife staffing. We will be meeting the new CEO and asking her to support and advocate the INMO’s position to underpin safe staffing with legislation. When services are staffed correctly, patients benefit and staff satisfaction and retention improves.”
Kevin Figgis
“It is essential the incoming CEO for the HSE ensures the workforce is appropriately resourced to meet the growing demands for healthcare services.
Most grades within the health service have no agreed minimum staffing levels to provide healthcare safely. Current staffing levels are often historic and bear no resemblance to the demand being made for service. This is affecting all areas of healthcare.
Services are often competing for an improvement in staffing levels due to budget and employment ceiling restrictions. This is no way to develop healthcare services. It places staff, patients, and service users at unnecessary risk.
Equally, there is an over reliance on expensive agency staffing or outsourced options to get around recruitment restrictions imposed by the Government.
The health service is changing. Services are developing in the community but need to be met with safe levels of staffing for all who work within the service.
Services such as mental health services, the national ambulance service, diagnostic radiology and radiation therapy, care staff and support staff all play a significant role in the provision of pre-hospital, acute and community care.
Service reconfiguration should be fit for purpose to ensure the needs of the local community are met with access to essential healthcare services.”
Linda Kelly
“Publish and implement a credible workforce plan for children’s disability services before attempting further reform.
The absence of a workforce plan for children’s disability services actively undermines repeated attempts at reform.
A workforce plan is not an optional extra. It is the basic strategic tool that ensures services have the right clinical staff, in the right roles, at the right time, and in the right place. Without it, policy change becomes little more than administrative re-engineering of an already overstretched system.
Recent reforms to the Assessment of Need (AoN) process illustrate this problem clearly. While measures designed to reduce reporting burdens or streamline assessments may appear sensible on paper, they cannot succeed if the underlying staffing crisis remains unaddressed. Children’s Disability Network Teams are already operating with hundreds of vacancies, while demand continues to grow.
In these circumstances, process reform risks simply redistributing pressure across an already depleted workforce rather than improving outcomes for children and families.
If reform of AoN is to deliver on its promise, the starting point must be a credible workforce plan that measures demand accurately, protects funded posts, and sets out a realistic pathway to staffing the service properly.”
David Cullinane TD
“It is difficult to isolate one key thing which needs to happen to turn the health service around but decompressing hospitals and delivering an accountable system with multi-annual funding, population-based planning, and clear regional targets will be essential to success.
My hope is that the new CEO adopts an honest and proactive approach to addressing the health service’s capital and workforce needs, including deep cooperation with key stakeholders like training bodies.”
Prof Gabrielle Colleran and Jim Daly
“We look forward to working collaboratively with the new HSE CEO to ensure that patients have timely access to quality care and that our highly trained specialists have the resources needed to both deal with current and future demand and to drive excellent clinical services at international standards across our health service.”
Pics: David Coleman / BobbyStudio; Medical Council; Dáil Éireann; SIPTU; and IHCA
Original source: ie