Strategy does not focus on leadership and management
The publication by the Department of Health of “Future Health: A Strategic Framework for Reform of the Health Service 2012-2015” is a further step forward in understanding the direction towards which our health services are heading.
The document brings some clarity to the overall vision for health service delivery while short on detail (understandably?) around some of the specifics and enablers, and particularly so as the system moves to the “Third Phase” and on to a UHI platform. The ‘known unknowns’ in this scenario remain to be fully worked through and there is a growing school of thought which questions the delivery of UHI in the timelines currently being discussed. Equally, the section on Integrated Care treats us to definitions and a literature overview, while failing to acknowledge much of what has been achieved in this area in recent years by the HSE (oops!). It would have been helpful to managers at many levels if this section declared a fundamental principle to protect what has been gained in service integration in recent years.
From my perspective, one of the bigger disappointments in the Strategy document has been the, almost token, – reference to leadership and management capacity. It appears in almost after-thought fashion at the end of the document and is the main focus of Action 48 (yes, the last action!) which states that the Department of Health and the HSE will further develop an approach to address “succession requirements at senior management level from 2012”. Surely this was an opportunity missed to lay the foundation for a formalised and properly accredited career development programme for managers; at entry, middle ranking and senior levels. Which nicely brings me to the last paragraph and the declared intention of the Strategy Document “to create greater opportunities for health professionals to influence the development and implementation of policy……through their professional bodies and representative organisations…… This will include medical, nursing and allied health professional disciplines”.
I re-read the last paragraph again to re-assure myself but only found comfort in the words “will include”. There is no discernible thrust in this Strategy to acknowledge, understand or exploit the potential of health service managers as a profession in their own right. This is not just an omission, but can also be described as a failure of analysis at a senior level.
At the end of the day, and when the lights in the strategising offices have been turned off, the total delivery of the services to the desired efficiency and quality standards is dependent on a manager corps that is trained, developed and equipped with the broad range of competencies to deliver in a highly complex environment. While succession planning at a senior level is to be welcomed, it does not address the underlying and fundamental requirement for formalised career development pathways for managers; and especially for those on the front-line.