Healthcare chief asks managers to consider nine questions on the future of the services

Stephen Mulvany, Acting Chief Executive, Health Service Executive
Stephen Mulvany, Interim Chief Executive, Health Service Executive

The Interim Chief Executive of the HSE has set out nine questions for healthcare managers to consider in the coming weeks as part of their ongoing work to better manage the health services.

Speaking to the HMI Conference, Stephen Mulvany said that he believed there was strong government support for funding health service developments, and that substantial additional funding was needed. But healthcare managers, including the HSE leadership, must also ensure that they were making the very best use of existing resources.

The questions he listed were:

  1. How we can help front line services to remove barriers to making the best use of the resources that are available now, while at the same time pursing further investment and recruitment?
  2. How we best harness the knowledge and potential for improvement and innovation of those closest to our care processes?
  3. How can we quickly engage the energy of our service managers, clinicians, front line staff, patients, service users and their carers?
  4. How can we improve things quickly, working with a staff of high quality health and social care professionals, many of whom are regulated clinical professionals?
  5. Can we make it easier to change and evolve at pace, despite the large heavily governed national change processes that often take sequential and cumbersome approaches to change?
  6. How can we maximise collaboration between the HSE centre, CHOs/ HGs and front line services?
  7. How do we retain and build on the best of what worked well for us during COVID, including greater front line ownership?
  8. How do we model behaviours and actions that might be key elements of what we hope to be hallmarks of operating under the new RHA structure?
  9. How do we maintain and enhance accountability and transparency including having whatever difficult conversations we need to have, to improve services but to do so in a respectful collegiate way?

Mr. Mulvany said in his view, some of the principles that should guide us in answering these questions were:

  • Everyone in the health service is assumed to want to do the best they can for service users, patients and their families.
  • The HSE Centre’s role is to create the conditions that allow for improvement.
  • The Centre is accountable, including to CHO/HG/Front Line, for its actions/inactions and how they impact on delivery of key priorities, and vice versa.
  • Similarly, CHOs/HGs are accountable to their Front Line, and vice versa.
  • Our conversations, at all levels, should be as data driven as possible.
  • At the same time, poor numbers do not necessarily mean poor performance – until data is clear we should all keep an open mind as to where cause and solution lie.

 “I think if we can together answer these questions and then act on those answers in a meaningful way we will be able to go a long way towards making progress in terms of people, structure and technology.”

Mr. Mulvany said the health services had been through a very difficult time over the last two and a half years.

 “I want to acknowledge the huge contribution every member of our health and social care services staff has made to our efforts to respond to the COVID-19 pandemic and the criminal conti cyber-attack. These people include not just our direct HSE staff but also our primary care colleagues, including general practitioners and Pharmacists, our private hospital colleagues and also importantly our section 39 and 38 voluntary organisation partners. 

“As we work to deal with the aftermath of the worst of the pandemic, and as we face into a period of further uncertainty with the oncoming winter, I want to thank each of you here today for all that you have done. I also want to thank each of you for the huge contribution I know you will make in the months and years ahead to providing and improving care to those that rely upon our services. With your help I know we can and we will make services better for our service users, our patients and their carers.”

Mr. Mulvany said he had worked in public service for the last 35 years, with the last 25 years of that spent in the health service. “The role I was happiest in was when I was privileged to be the 1st National Director for Mental Health Services. There is something about being able to directly work with dedicated clinical and other colleagues, and with service users and other stakeholders, to shape and improve services to people that, despite its challenges and occasional heartache, I have always found to be both an awesome responsibility and truly inspiring.”  

He said his first month in the role of Chief Executive Officer of the Health Services Executive had a strong focus on engaging with as many front- line staff, service partners and managers as practical. “This has been centred on listening to and understanding their challenges, opportunities and innovations, with a view to being better able to support them going forward. I have met with colleagues from a variety of service areas such as Disability Services, including voluntary service colleagues, Older Persons Services, Ambulance Services and Acute Service, including professional groups. It is key, in my view, to tap into the knowledge and ideas for improvement and innovation of those closest to our care processes, especially our front-line staff, patients and service users, and I intend to seek out opportunities to engage with all of these stakeholders in the weeks and months ahead.

“I have, to date, heard first-hand how the clinical programmes and other initiatives are making a real difference to patients and service users and to the delivery teams in helping them do their jobs. This is most encouraging.  I have also heard of the challenges being faced by families seeking to access, and staff trying to deliver, our disability services. In each of my engagements I have been greatly impressed with the dedicated, caring nature of colleagues and teams and their passion and energy for their work and for their commitment to their patients and service users.

“I am acutely aware that we all need to create the right conditions and circumstances to enable our colleagues to better integrate their services around the needs of those that rely upon those services. We must retain, in so far as practical, and build on, the best of what worked well for us during COVID-19, including greater front-line ownership.

“Our health and social care services need very substantial additional investment if we are to deliver on our full potential to provide high quality services that represent value for the people of this country. To me quality and value can be used interchangeably and their characteristics involve safe care, effective care, patient centred care, efficient care, timely care and equitable care.

“I want to acknowledge and thank our Minister for Health and Government for the very significant support, including financial support provided to the health services in recent years. Over the last two years they have invested €1.4bn in new service development funding to permanently strengthen our health and social care services, in addition to funding to maintain the existing level of services and once-off funding to deal with COVID-19.

He said he had been very heartened by the interaction with many colleagues at the six regional Sláintecare RHA events that took place recently around the country.

“It came across to me very strongly from those events that we need to find better and quicker ways to:

“At all times keep an open mind as to causes and solutions of underlying issues.  More resource is definitely the answer in some but by no means all cases.

“Facilitate a shared view of risks either side of handover points between services.

“Assist in getting the key stakeholders around the table.

“Clarify objectives and rulesets, and clear unnecessary blockages.

“Identifying menu of practical supports, particularly in terms of digital and data, to help CHOs / HGs to help the front line”

As we look ahead to the winter period my two priorities over the coming months are to help you to protect and improve access to our community and hospital scheduled and unscheduled services, and to improve our engagement with our staff and the people who use our services.

It is very clear to me that the people in this room are an absolutely key resource for the health services. You have made a huge contribution to all that has been achieved in very difficult circumstances over the last two and a half years.  As we face into the uncertainty of winter, I know that you will continue to bring your knowledge, experience and expertise to bear on solving key problems in collaboration with our services.”