A MAJOR Government review of the Department of Health has found that it has not yet got to grips with managing the Health Service Executive (HSE), that allocation of staff is very “uneven”, and that staff morale in the department is at a very low level.
The second report of the Organisational Review Programme, published yesterday, highlighted major issues facing the department, especially since the establishment of the HSE in 2005 and also of the Health Information Quality Authority.
The review process commenced in 1998 and assesses the performance, customer service and strategy of Government departments.
Yesterday’s report also reviewed the Revenue Commissioners, the Central Statistics Office, and the Property Registration Office. In contrast to the Department of Health, the review programme praised the strong leadership, effective organisation and prominent innovation culture in the Revenue Commissioners.
The report concluded the department had not succeeded in clarifying its roles and responsibilities vis-a-vis the HSE, in particular. It also said it needed to “become better at managing the delivery of all its agencies [including the HSE]”.
“To do this, it needs to become stronger at goal setting, measuring outputs and outcomes, and managing performance so as to ensure the implementation of its policies.” The report also found the quality of leadership within the department is “uneven” and said there was a need to communicate more effectively to staff after the creation of the HSE in 2005.
“It was evident . . . that staff morale is at a low level. The confusion amongst staff as to the role of the department and the lack of clarity around whom the department’s customers are, coupled with the feeling of being constantly under fire politically and in the media, are all factors contributing to the poor morale . . .”
The report accepted that such fundamental changes as occurred with the setting up of the HSE cannot happen overnight. “A good deal of change has taken place in the department in the five years since the creation of the HSE, but the journey is not over and a lot more still needs to happen.”
It was very critical of staff allocation which it concluded was very unbalanced. “It is clear, particularly at the more junior levels, that some staff are overwhelmed with work while at the same time some staff in other areas have little or nothing to do.
“There appears to be a real reluctance at middle management levels to tackle this problem; in the staff survey it was this particular issue that provoked the most negative reaction of all.”
The report acknowledged that health sector issues were rarely off the public agenda and cited the impact of such controversies as the Hepatitis C tribunal; the Lourdes Hospital inquiry; the Leas Cross commission; the Monageer inquiry and the Postmortem Practices and Procedures report.
“Taken together they show a department that is frequently under siege, trying to firefight much of the time, and trying to cope with considerable external pressure.”
It praised the strategy-setting of senior staff for the primary care and cancer control strategies – described as “exemplars” – but called for more consistency.
The ill-fated Ppars information technology project, which racked up costs over €100 million, has led to a “loss of confidence”about major health sector ICT projects, according to the review.
Revenue under pressure: fewer staff to chase tax
THE REPORT on Revenue found little to criticise. It said the most significant challenge facing the agency was replacing corporate knowledge as a result of experienced staff taking voluntary redundancy, retirement and early retirement.
It also highlighted a potential resource issue. “In the short term, the downturn in the economy is putting special pressures on tax collection – notably, greater effort is now needed to secure tax intakes from an increasing number of businesses experiencing cash-flow pressures. Activity in the hidden economy and the risk of evasion of tax may be greater now than in recent years. The resource constraints mean that these challenges will have to be met with a smaller and less experienced staff cohort,” it stated.
The report praises the internal leadership of Revenue as very effective and also said innovation within Revenue was very strong.