New low as relations between Department of Health and HSE deteriorate

For two organisations due to merge, Department of Health and the HSE show little sign of peaceful co-existence. The correspondence between their respective heads reported today in The Irish Times, however, marks a new low.

The latest disagreement between HSE director general Tony O'Brien and Department of Health secretary general Ambrose McLoughlin relates to pay policy and, more specifically, to the talks on consultant pay getting under way with the Irish Medical Organisation.

More generally, though, it shows the enormous tension the health system is under, and the effects of this stress on its upper echelons. For more than five years, the troika has been telling Ireland it is spending too much and cuts must be made. The view that the health service is rife with inefficiencies is broadly shared by the Department of Public Expenditure, the main enforcer of cuts in expenditure across the public service.

But with more than €3 billion shorn off its budget in recent years, the HSE says it can’t give any more. And yet the demand for cuts keeps coming, with more than €600 million to be taken off the health budget this year.

Targets are off course this year, and the blame game is well under way. Numerous changes have been made at senior management level, while other posts remain unfillable at the salary offered. Last week, chairman of the Dáil public accounts committee John McGuinness called for the resignations of O’Brien and McLoughlin.

Meanwhile, some cuts, such as the ill-fated medical card “probity review”, have backfired. HSE staff have born the lion’s share of the blame for a cut imposed externally on the executive.

An earlier cut, the 30 per cent salary reduction imposed on newly appointed consultants in 2012, is the subject of the past week’s tetchy exchange of correspondence between O’Brien and McLoughlin. This measure, merited on the grounds of fairness and cost reduction, was poorly executed and has proved counterproductive.

Much needed consultants voted with their feet, moving to other countries where the pay is higher, the working conditions better. Yawning gaps in the staffing of hospitals have been plugged by the short-term agency doctors, at far greater expense and some risk to patients.

In his letter to McLoughlin, O’Brien makes it clear he wants the 2012 pay cut substantially reversed. McLoughlin reminds him that Government decides on pay.

The sense of drift in health policy is undeniable. Minister for Health James Reilly is not expected to survive the forthcoming reshuffle, while Minister of State Alex White's attentions are directed on his bid for the Labour leadership.

Financial targets are being missed, critical posts remained unfilled and morale is low. The situation is becoming more critical by the day.