Prof Brendan Drumm's decision not to take up the post of chief executive of the Health Service Executive (HSE) has caused surprise and genuine disappointment in the health service.
By general agreement, he was an outstanding choice for the post - an admired and experienced doctor and administrator as professor of paediatrics at University College Dublin and consultant paediatric gastroenterologist at Our Lady's Hospital for Sick Children in Crumlin. A mood of anticipation was growing in advance of his taking up the job.
His decision represents all the greater a setback for the HSE since he is the second chief executive-designate not to take up the post, following Prof Aidan Halligan's earlier withdrawal. Now, a fortnight before the final transition from the former health board structure to the single, unified, national health service takes place on June 15th, the search for a chief executive must begin again.
Prof Drumm's appointment collapsed because the Government was unwilling to give him the guarantees he wanted in relation to a professorship and consultant's appointment at the end of his fixed term as HSE chief executive. At first sight, it is surprising that some mechanism could not have been found that would have allowed Prof Drumm to return to his academic and medical career at the end of his HSE term.
As a result, the Government has lost its man for the second time, leaving a real sense that the Irish health system is somehow becoming ungovernable.
The chief executive of the HSE is responsible, directly or indirectly, for 100,000 staff and an annual budget of €11 billion. Against that backdrop, a salary of €320,000, potential bonus of €80,000 and a pension do not seem overly generous when compared to the earnings of some senior managers in the private sector and some medical consultants heavily engaged in private practice.
In order to attract the best candidates, it is important that there is complete clarity on the HSE's functions and powers. Under the legislation setting it up, it is supposed to run the health service, while the Department of Health draws up policy and monitors the HSE's delivery of the service. But wooliness has been creeping in. Take, for example, the €500 million a year earmarked for capital development projects. It is still not clear to what extent the Minister for Health expects to have a role in deciding how and where this is to be spent.
Getting the HSE up and running under the leadership of a capable, innovative and motivational chief executive remains a key priority for the Government on which it continues to fail to deliver.