WITHIN weeks the same person was offered the two top jobs within the Irish health-care system - chief executive of the VHI or co-ordinating management responsibility in the eight health boards.
Denis Doherty, who has been involved with health boards since they were set up in the 1970s opted for the second. He is the first director of the newly-established Office for Health Management. He will put in place a programme of change designed to improve the quality of the health services, which employ 60,000.
"It is the beginning of a new approach to development in the health services," explained Mr Doherty.
"Hopefully through leadership the talents of people will be allowed to develop right through the system, benefiting ultimately the users of it."
A strategy outlining those steps will be published at the end of the month by the Minister for Health, Mr Noonan.
The Irish system is a resilient one, having survived the cutbacks of the 1980s, explains Mr Doherty. However, change is needed. "No other country reduced its health-care spending to the extent that was done here. It is incredible that it survived. We compare very well in the European league, but we need now to keep up with the times."
"I am looking forward to the challenge. Health boards needs a high level of management and the way to develop that is to develop our managers. It is true to say that we have not, up to now, developed people to realise the enormous potential that is there."
Better management, he said, will involve an examination of how the role of the hospital is changing. Hospitals need to have more contact with the community. Many are serving small rural populations and since it is not acceptable to that community or to politicians to close them they must adapt, he said.
The day of the general surgeon is almost gone and consultants are now operating in specialities and sub-specialities.
"Hospitals should be grouped for service purposes. In Portlaoise there is an excellent unit on breast disease, as good as any in Dublin, and it takes referrals from outside its catchment area. A similar thing is happening with gastroenterology in Tullamore. In Ennis now a surgeon is travelling from the Regional Hospital in Limerick. He holds a clinic and is doing day surgery in the morning. He reviews the patients in the afternoon and discharges them. The alternative is not the hospital as it used to be or no hospital, but a different hospital catering appropriately for local needs.
The "real" opportunity is to develop primary care. "We have very well-qualified general practitioners capable of doing a range of procedures. Hospitals need to be opened up to general practice... with more collaboration between GPs and staff in the hospital."
The task of looking after chronically and terminally ill people at home also needs addressing. "We, hear politicians talking about escalating costs compared to 10 years ago, but you are not comparing like with like. We need to deliver on what we know patients want, and that is proper care at home. The cheapest way to look after very ill patients is to warehouse them. But the quality of life is very low. We have a respect for human life and we need to face up to the costs if we are to keep that," said Mr Doherty.
The final arbiter of social gain is the patient. "But there are ways of measuring the competence of the unit that does that work, to measure the patient satisfaction, and putting those together."
He gives the example of independent research into family planning services carried out in the Midland Health Board area. "We would not have had a lot of complaints but it turns out there was dissatisfaction about the choices available. As a result a lot of GPs have adapted their service and the Well Woman is now operating in Athlone. It is just a small example but a good example of what can be done."
Mr Doherty, who is also president of the Standing Committee of Hospitals of the EU, adds: "Protocols need to be developed and quality programmes put in place involving the entire system. These issues are the same as those facing health services managers across Europe."