Bernard Gloster, who took over at the helm of the Health Service Executive (HSE) on Monday, comes highly regarded by those who have dealt with him in Tusla.
He was appointed chief executive there in 2019. He previously spent more than 30 years working in the health service, including in senior management, community and hospital operations. He is a social care worker by profession, with an MBA from Oxford Brookes University and an MSc in Management Practice from UCC.
He will need all his talents to make a difference at the HSE, which is beset by many challenges. Here are some of the main ones.
Waiting lists
One in four of us is on some kind of health waiting list. Far too many people have been waiting for unacceptably long times; for example, more than 150,000 people have spent more than 12 months on the waiting list to see a consultant.
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There is money available to tackle the problem – €350 million last year, though not all was spent – but up to now it has made only a small dent in the numbers. Further, much of this funding is being spent in the private sector, where it does nothing to tackle the long-term resource problems in public hospitals.
Staff
Many health service staff are burned out after the Covid-19 pandemic. Further waves of flu, overcrowded hospitals, poor management in many areas and the after-effects of the 2021 cyberattack on the HSE’s IT systems only add to the difficulties of an average working day in the health service.
As a result, many staff are leaving. The churn rate is higher than it ever was. Absenteeism is rising. Those staff left behind to plug the gaps are under more pressure than ever. While Irish healthcare workers have always emigrated in search of experience and adventure, there are fears the generation who are leaving now might never return.
New staff are being recruited faster than ever, it is true, but the rate at which they are being added is not sufficient to meet soaring needs.
The new HSE boss will have to motivate and inspire staff, as well as having their back in the inevitable crises ahead. But he will also have to take practical steps to make working in the health service more attractive and less stressful.
Sláintecare
The implementation of Sláintecare, the big-ticket reform programme for the health service, has been “piecemeal” so far, an Oireachtas committee heard last week, and even insiders don’t know who is in charge. It is also years behind schedule, though there is some renewed momentum, with new regional health bodies set to get up and running later this year.
As the operational arm of the health service, the HSE doesn’t get to decide how fast Sláintecare is implemented – that’s for the Department of Health to decide. But, equally, Sláintecare won’t happen without proper consultation with and buy-in from the HSE.
[ Tusla chief executive Bernard Gloster appointed as next head of HSEOpens in new window ]
IT systems
The HSE’s IT systems are a joke. The 2021 cyberattack was an accident waiting to happen, insiders freely admit. And while there is a plan to upgrade systems and introduce a proper e-health system, the HSE says it will take 20 years to complete.
Staff and patients can’t wait that long. One of Gloster’s main challenges will be to inject urgency into plans to digitise health records. We cannot expect staff to continue humping around paper records in hospitals for another decade and beyond. One quick win would be to introduce a new payroll system that will put an end to staff being put on emergency tax while they move from one training post to another.
Accountability
If Gloster really wants to break with the past, he will have to take steps to make the HSE, and particularly its senior managers, more accountable. When doctors or nurses are the subject of a complaint, they can end up before their professional bodies, yet there is no way of holding senior HSE managers accountable. Far from being sanctioned for errors that had disastrous outcomes for patients, some managers ended up being promoted.
There are excellent examples of good practice throughout the health service. The problem areas are clearly apparent, and yet the HSE does little to ensure they are run better. The traditional culture of closing ranks is inimical to any proper reform of the system.
And finally…
Gloster could start by publishing the HSE service plan for this year, which has yet to appear and is currently marooned in the Department of Health.