New chief of HSE must be recruited from abroad

Whoever takes up the reins at the HSE must have a remit to ignore the sacred cows in our health system

SO, THE worst kept secret in Irish healthcare is out: Mary Harney would like to see Prof Tom Keane, interim director of the national cancer control programme, appointed the next chief executive of the Health Service Executive (HSE).

Speaking to reporters in Cork last week the Minister for Health said: “There is nobody more than me would like to see Prof Keane stay in Ireland, he has done a remarkable job.”

Of course, Tom Keane has no intention of ever applying for the post. He came to Ireland on secondment from the cancer control agency in British Columbia. In doing so, he left children and grandchildren behind and, as you might imagine, the quietly spoken but extremely effective professional would like to get back to his home, his family and his career in Canada. He certainly owes us nothing: indeed if we had a formal honours system, I have no doubt he would be accorded the highest honours in an Irish equivalent of the New Year’s honours list.

The chances of Keane taking over from Drumm next year lie somewhere in the realms of a snowball’s chance of survival in the intense furnace of hell. I suspect Harney knows that: why else would she make such a statement within days of the publication of a formal advertisement for a new HSE chief executive?

Indeed, if she is serious about Tom Keane getting the job, the taxpayer is entitled to ask why the public purse is forking out €100,000 to a headhunting agency to find a replacement.

The advertisement from headhunters, Amrop Strategies, notes the HSE “is the largest organisation in the country with a budget of €15 billion and a staff of 110,000”. In a list of key requirements, Amrop says candidates will need “experience of operational excellence in delivering significant and complex organisational change and performance improvements”.

All well and good, but how about being more specific? It is not unreasonable to ask that only candidates who have managed organisations over 50,000 employees need apply? How else could someone have the necessary confidence and experience to manage an enterprise of 110,000 people?

Drumm’s successor must not be a doctor. Why? Doctors, no matter how able, are not trained to manage – and no matter how far up the medical administrative ladder they may have risen, it would be unusual for them to have managed more than 500 staff. And it’s time we got over the myth that medical expertise somehow conveys an advantage in undertaking the chief executive’s role. In fact, it is probably a disadvantage.

What a new chief executive needs is a good clinical director who is medically qualified and who has an ability to think and advise “outside the box”.

At the risk of being accused of a lack of patriotism, I propose that no applicant who currently works in the Irish health system should be shortlisted for the job.

Apart from his outstanding personal qualities, one of the main reasons Keane was successful in his role was that he left Ireland not long after graduation. As a result, he was unfettered by the parochialism and red tape that marks out health service management in this State. We have a questionable ethos at the core of health administration, one which the creation of the HSE was designed to remove but which has mushroomed to the point where some of the former health boards in Ireland are now beginning to look like paragons of virtue.

Whoever takes up the reins at the HSE must be brought in from abroad with a specific remit to ignore the many sacred cows in our health system.

Whether it is dealing with consultants, hospital porters or managers, what this State badly needs is a single-minded individual who is determined to implement a three-year shake-up of the HSE.

As for kitchen cabinets, it is time we went minimalist. In four years, we have paid out some €3.6 million to Drumm’s close advisors. Harney may be remembered for her work in improving cancer services but she will certainly be remembered as the minister who set up the HSE and presided over its years of binge administrative recruiting.

Probably not the legacy the former PD leader had in mind when she took the job.