Those of us working as managers in the health services could not have failed to sit up, take notice and reflect on three particular items which attracted a lot of media coverage over the past weeks. In no particular order these were:
Richard Dooley, President, HMIthe over-expenditure in acute hospitals
the plans around Emergency Departments in Roscommon General Hospital and Loughlinstown Hospital
the remarks of An Taoiseach regarding hospital managers
These of course are all connected and are symptoms of a system malaise that all of us have had to contend with. And if you are a hospital manager you will understand this better than most. This is not the first time that I have written about local political agendae, including medical politics, engaged in unholy turf wars in holding what we have and trying to defend the indefensible. Todays hospital managers have been handed a legacy of uncoordinated planning and poor strategic thinking which is manifested in a proliferation of acute hospital services: one for everyone in the audience so to speak, and all trying to deliver the same services. Add to that the lack of proper IT system support, poor integration and a level of public and political scrutiny not seen heretofore. It is true that the National Clinical Programmes, and the Acute Medicine Programme, will seem to address this and somewhat rationalise service delivery. But even in this context you don’t have to go far before the old fears and local loyal ties present themselves. Managing in an acute hospital today in this environment is as close to trench warfare as any of us will ever want to be.
It is heartening however, in these straitened times, to come across some good local clear thinking regarding acute services. The article by Stephen Donnelly, Independent TD (July 17, Sunday Independent) on the challenges facing Loughlinstown Hospital is worthy of a read. It is refreshing in its honesty. Furthermore, it is the type of honesty required across society at large if we are to deliver the appropriate service, to the required quality standards and within resources available.
