HMI 75th Anniversary Time Capsule

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HMI Time Capsule
HMI Time Capsule

To mark the 75th Anniversary of the HMI, a time capsule – to be opened in June 2045 – will be buried on the campus of HSE Grangegorman Primary Care Centre, at Grangegorman Upper Road, Dublin 7 

The time capsule includes objects which are symbols of how the HMI wishes to be remembered and pass onto future generations. It also includes objects that featured very heavily in the lives of healthcare managers at this time. 

The objects we collated include: 

The first three items will provide a snapshot to future generations on the current work and history of the HMI and this is complemented by a personal letter from Breda Crehan-Roche. 

In the past 250 years, Grangegorman has been the site of a workhouse, a hospital and a prison, and now is integrated into Dublin city as a health and education campus. The buildings of Grangegorman stand as architectural monuments to that past and its complex histories. The Grangegorman Histories’ diverse programme of events, publications and learning opportunities will help future generations to uncover the history of the site and surrounding communities. 

Given the pressures on all aspects of health and social care services during 2020 and 2021, due to Covid-19 it is only fitting we include some of the symbols from this time. 

We hope it provides snapshot of the experience of the HMI as an organisation and the people it supports. 


Where will Health Services and Health Managers be in the decades ahead – HMI Vice President’s letter in the capsule

My name is Breda Crehan-Roche and I am Vice President of HMI and Chief Officer of Community Healthcare West. I have been asked to write a piece for a time capsule on the 75th anniversary of HMI. The title of the piece is, Where will we (Health Services and Health Managers) be in 10,15, 75 years and what advice would I give to future managers.

Backdrop to Healthcare Services

I am writing this piece in May 2022. Ireland has had a very challenging two years. Beginning in early 2020, COVID 19 fundamentally changed our world and all that we have routinely come to expect as normal. COVID 19 pandemic created a precedent in the history of our world and in Irish Healthcare provision. Never before were so many challenges experienced in such a short time. We witnessed the devastation caused in our lives and in our communities. COVID 19 had dramatic effects globally in terms of disease, ill health, increased mortality rates and severe financial pressure on global economies and health services.

Staff at all levels in the Health Services, HSE, private hospitals, non-statutory providers and voluntary groups faced the daunting task of infection prevention treatment and care. New roles and new ways of working were developed, often going beyond the call of duty. Towards the end of 2020, the Covid 19 vaccination programme commenced a game changer in health services, offering hope and Irish people took up the COVID 19 vaccination in huge numbers. This vaccination programme again required extraordinary efforts from healthcare staff and retired staff also took up the challenge.

Learning from the COVID 19 pandemic has greatly impacted how we deliver Health Services across Hospitals and Communities. Huge lessons have been learned which have impacted on the way we provide services and the design of buildings needed to ensure infection prevention control. Ventilation and space were challenged, as many buildings are old and have health and safety and environmental issues. The coordination of emergency management and all government departments involving HSE, Local Authorities, An Garda Siochana and many others, too numerous to individually mention, ensured a coordinated and an integrated approach to our response at local, regional and national level.

Lessons were learned from the HSE 2021 cyber-attack, which caused major disruption to our services. Healthcare relies on good information communication technology and for several weeks we had severe impacts on our services. Investment in telemedicine, ‘Attend Anywhere,’ Microsoft Teams, Webex and Zoom, to name a few, and working remotely, are now the norm. On-line, while very efficient, does not replace in-person meetings, teams flourish when they are together and we need to ensure that staff do not become isolated and that staff have a right to disconnect from work. We are also too accessible and the urgent can drive the important out, so time management is now a critical skill.

In 2022, war in Ukraine impacted on healthcare services, with many people displaced and arriving in Ireland seeking a safe haven. At the time of writing this piece, 30,000 people have arrived here with requirements for health, education, housing etc.

Policy Direction

In 2017, the Irish Government published Sláintecare, a 10 year plan for health services. This plan recognises the flaws in the ways we organise and deliver healthcare currently, it also recognises that these problems will only exacerbate as our population continues to grow and to age.
Sláintecare is and ambitious plan and at its core, it aims to create a single tier health service with universal coverage for all of its citizens. It also aims to shift the focus of our health service away from an unhealthy reliance on hospitals, to provide a range of care that would be better delivered in the community. It also aims to build on the progress that has been made within our hospital system to rationalise our approach to cancer diagnosis and treatment, trauma care, specialist cardiology services and a range of others.

In 2022, the Government announced that the implementation of six Regional Health Areas (RHAs) within the HSE, on the basis of the geographical boundaries agreed by the Government in July 2019. Design of the RHAs will be completed in 2022, there will be a phased introduction of the new bodies in 2023 and they will be fully operational from 2024.

Each RHA will be able to plan, resource, and deliver health and social care services for the needs of its unique population. This will result in improved accountability and governance in terms of finance and performance. It will also empower frontline staff and bring decision-making closer to the frontline. It will enable and empower staff to provide services that are, integrated, locally planned and delivered, easier to access and navigate and available closer to home

The Future

Where do I see health services and the impact on Managers in 10, 15, 75 years? The future is difficult to predict, if the past two years are an indicator of the pace of change, we can expect significant change. Service users and patients are no longer passive recipients of care and treatment and are more and more becoming involved in shared care, coproduction and codesign of their treatment and care, which will require information technology to be timely, flexible and user friendly. With a recognised need and focus on digital transformation of the delivery of health and social care services, robotics will provide new opportunities – giving people control of their own health. Health and social care organisations will be more flexible, especially for women or whoever is the lead “carer” for children and/or older family members. This is a perquisite to ensure we retain and more importantly continue to attract people into health and social care professions.

Peace and stability will continue to be a challenge globally, famine and war will unfortunately continue, with nuclear and chemical warfare highly likely, cyber-attacks will continue, there will be more pandemics, air and water quality will become an issue for countries, people will be displaced which will challenge healthcare and social care provision.

My advice to future health managers;

You will need to be resilient, an excellent communicator, adaptable, flexible, accountable, compassionate and an agent of and leader of change. History has taught us that that people who are adaptable can handle change, managers will need to embrace change to thrive in the future. The future will challenge, but also provide opportunities for staff and service providers to be more creative, to be truly person-centred and to empower and educate staff and people to have more control and choice in their daily lives. The service providers who persist in providing the standard approach to service provision will fast become outmoded and will have forgotten the sage advice that the world belongs to those who are flexible.
I will leave you with this quote, the one constant thing in our lives is change. We cannot avoid it and the more we resist change the tougher our life becomes. Change as John F Kennedy quoted is a Law of Life.

So be brave, be kind, be flexible, embrace change and diversity, remember the world is your oyster and there are wonderful opportunities ahead.

Breda Crehan-Roche, Vice President of HMI, Chief Officer of Community Healthcare West.