We must re-define structures and functions
March 1 has come and gone and the much-vaunted ‘crisis’ in health service delivery, occasioned by the exodus of thousands of skilled staff, has passed in a relatively calm way. The service adjustment (ongoing) remains a challenge, the manifestations of which will present as both problems and opportunities for service managers at all levels for some time to come.
The recent exodus, however, is but one in a series of actions and measures to hit the health services over the past four years. From a national perspective, the necessity and rationale for such actions is evident and accepted. However, the cumulative effect of these actions and measures, which have been blunt and non-discriminatory in their implementation, has been to spawn a level of control that is disproportionate and seems to erode the role of managers within the system; to dent system confidence in managers and ultimately the managers’ own self-confidence. This, unwittingly perhaps, has potential to bring the delivery system into tricky territory where patient care imperatives can be put aside and where local managers do not have the latitude, flexibility or structural wherewithal to deploy their resources to the areas of greatest need. The consequences for morale are enormous and challenging for managers more so now than ever. It is a problem that cannot be ignored.
The urgencies around this must not be lost on policy makers. The actions must be progressed to re-define structure and function for the shape our health service will take. In parallel with this, and as stated oft-times before, there must be a formal and properly accredited health service management career pathway to develop the competencies (strategic, tactical and technical) to lead and manage health service delivery into the future. This must be agreed and developed without further delay.