When is sauce for the goose not sauce for the gander?

Dr Kieran Moore

Dr Kieran Moore

Patients have the right to expect that all staff paid to  serve them be regulated and accountable, or do they, asks Dr Kieran Moore, Consultant Paediatric Liaison Psychiatrist.

You are the CEO of a factory that makes medical products for patients with serious heart disease. Put simply when your tiny technologically advanced pieces of engineering are inserted into diseased hearts, they save the lives of millions of people around the world.

As the CEO it is incumbent upon you to ensure that every product manufactured is perfect as even the tiniest imperfection can result in death. You invest whatever it takes to make sure that the machinery and technology used to manufacture is always up to date. You know however that the tools professionals use are only as good as the expertise of those using them and you decide to implement a system the guarantees the professionals making the product have that expertise.

You set up a body to regulate employees populated by professionals from outside the company. You call it the ‘regulatory council.’ The job is to ensure that all those working in the factory are transparently registered, adequately trained, competent and that they verifiably keep themselves abreast of all the relevant up-to-date advances in their field. If there are problems with performance of any sort, the regulatory council is mandated to investigate whether employees are fit to practice their job and if not to impose appropriate measures – including sanctions up to dismissal.

Apart from the ethics of keeping patients alive you know that the company’s shareholders will be less than happy if the company loses money because of safety issues.

Satisfied with yourself, you employ a raft of managers to manage all these professionals in the factory. When recruiting the managers, you don’t stipulate any minimum professional qualification, suggesting only that they have “relevant experience.” This is in direct contradistinction to the recruitment of all other professionals in the factory who must have a professional qualification to practise. It later turns out that 94% of the managers you employed have no professional management qualifications whatsoever. In your wisdom you also decide that there is no need to implement any regulatory scheme for managers as opposed to the professionals they manage, because in your view it would be “overly restrictive.” Equally not wanting to be viewed by your management colleagues as being ‘autocratic’ you don’t clearly outline what area of the company each manager is responsible for except that you are ‘the boss.’ As the complexity of the company grows and concerns are voiced about safety and governance your response is to recruit more managers of the same ilk. This has the knock-on effect of diminishing the money available to recruit professionals directly involved in making the final product.

Is this company likely to be trading?

According to its own website: “the health service executive (“H.S.E.”) in Ireland provides health and social services to everyone living in Ireland…. young and old, in hospitals, health facilities and in communities.” The website also says: “The H.S.E. is required under section 35 of the Health Act 2004 to have in place a code of governance. Governance can be defined as the framework of rules, practices and policies by which an organisation can ensure accountability, fairness and transparency in an organisation’s relationship with its stakeholders.”

Almost every employee working in the HSE is regulated externally. However there is no external regulation of managers.

In the H.S.E. the vast majority of new jobs advertised stipulate under ‘qualifications/experience’ that the applicant have a minimum educational qualification and experience. Registration with the appropriate regulatory body is also required. Stipulations for managerial jobs in general outline only ‘significant experience’ with no requirement for a professional qualification or registration with a regulatory authority.

A report drawn up for the H.S.E. in 2013 by PA consultants found that just 16% of finance staff interviewed in the HSE had accountancy qualifications. The report said that hospital policies at the time were that of filling finance posts “with a general administration person irrespective of experience or knowledge”.

According to figures presented to its board the H.S.E recruited five times as many managers as it did doctors and nurses in the second quarter of 2021.

Is this company likely to be trading?

Our Irish language is replete with pearls of wisdom. One of its great proverbs is: “Ní bhíonn an rath ach mar a mbíonn an smacht.”  There is no prosperity without regulation.