Health managers did not receive the kind of training and support which consultants did and this must be changed, Health Minister, Dr. James Reilly, T.D., said when he addressed the HMI National Conference. Maureen Browne reports.
“Some people say it costs at least €1 million to train a consultant and then there is the on going training. I don’t think managers receive that kind of training and support and we need to change that.
“We have never sufficiently valued strong leadership in the health services. These skills must be nurtured, encouraged and, if necessary, taught to our managers. I know that good work is already under way in training and developing managers which is a very positive development.
“The Irish College of General Practitioners was the first College in this country to insist on a communications model for all its trainees. GPs are good communicators but we cannot expect people to be naturally good communicators and have a module on communications underlines its importance.”
The Minister said good organisation and good management saved lives in the health services and health managers were the people who would drive the culture of change which we needed to give us high performance over the short and medium term.
“Dr. Susan O’Reilly, Director of the National Cancer Control Programme would say that as a result of the new re-structured cancer services we have improved mortality by ten per cent. If we found a drug like that, we would all be clamouring for it.
We have never sufficiently valued strong leadership in the health services. These skills must be nurtured, encouraged and if necessary taught to our managers
“We have been driving around in the dark until recently, because we had little or no information. We didn’t know what the problems were. We’re now developing headlights and new navigation lights. You are the people who will drive this change and later when the services are radically improved, you will be able to say ‘I was there and I played my part.’”
Dr. Reilly said that in the health services we had to do better with less, because we had no choice and he wanted to see patients and clients to be part of the decision making.
“For example, in the west it was decided that, instead of asking people to come to the regional paediatric clinic and possibly waste time if this was unnecessary, parents should be texted in advance and asked if they thought their children needed to attend. Parents know their children and this has worked very well. It is a huge cultural change to bring clients and patients into the decision making process and lose the paternalistic attitude.
“I want to go further in relation to outpatient departments. I want each person to be treated with respect and given a separate appointment and I want all outpatient attendees texted at least three days in advance and asked to text back “y” or “n” to let us know if they are planning to attend. They will be reminded again on the day of the appointment and if they don’t respond or don’t turn up, I don’t think it unreasonable that we should charge them next time.
“We have already had considerable improvement in the service – trolley waits are down 22 per cent despite budget cuts, there have been significant reductions in waiting lists for admission.
You are the people who will drive this change and later when the services are radically improved, you will be able to say ‘I was there and I played my part’
“I think if we are open and fair with each other, we can all do so much better and change the use of time and expertise. Already 3,000 staff have been redeployed and local managers have fundamentally reviewed their rosters to ensure that they are used in the best possible way. For example, Our Lady’s Hospice in Harold’s Cross Dublin is saving €220,000 per annum, staff are co-operating with clinical care programme changes, the Acute Medicine Programme is saving €72 million, allowing us to treat more patients, the Productive Theatre is saving millions and I am assured the Clinical Programme for Stroke will save one life a week and prevent three more people from ending up in long term care. Care in the community is improving and 120 community mental health teams are in place.
“Consultants have agreed that they will be rostered over seven days and Clinical Directors will have a much strengthened management role in respect of their consultant colleagues. This means we will have senior decision makers available around the clock and I believe this will save us nearly €200 million a year.”
Dr. Reilly said that for too long politicians particularly had focused on inputs and never measured outcomes.
“But we are now starting to do that and to measure what is and what is not effective. We have outcome measurement in hospitals now but not in primary care. It is great that you can see GP the day or the next day but – although I believe it is true – we don’t know if that is good for patients. We need to see what GPs are doing which does not improve outcomes and get them to stop doing those things. As we move to free GP care, I think we will see more work done by practice nurses and more patients moving from hospitals to community care. For examples when we started triaging orthopaedic patients by physiotherapists we found that 50% did not need to see an orthopaedic consultant, they needed to see a physiotherapist.
“We need greater efficiency and better outcomes and this is about managers who manage. Absenteeism has to be tackled by strong managers. Why does one hospital have absenteeism in the same staff grade which is three times greater than another? Would you find that this hospital has more people on trolleys and more difficulty managing its budgets?
“We need to reinvigorate Croke Park and ensure it continues to deliver. We have almost finished quantifying the numbers waiting for an outpatient appointments which stands at about 360,000 and we are now addressing this.
“We will introduce the Universal Health Insurance Bill, in the HSE we will provide for Directorates headed by a Director General to be accountable to the Minister, the Minister will be empowered to specify priorities.
“The change in the HSE structures will be profound and will offer challenges and opportunities.
“We stand at the cusp of an enormous and unprecedented task and you as Managers are at the sharp end of it.”