HSE...or KGB?

  • Niall Hunter, Editor

The HSE has shipped a lot of criticism since its inception in January 2005. Much of this criticism is justified.

Brendan Drumm, in an article in the latest HSE staff magazine, points out that it is a very new organisation. He waxes lyrical about the changes taking place. Alas, his enthusiasm for this transformation process was not sufficient to encourage him to seek another five-year term at the helm.

For in fact, the HSE is a very old organisation with very old attitudes.  If you allow your dizziness from the relentless spin to abate for a minute, you will realise that in terms of organisational style and substance, it's not very far removed from the old and inefficient heath board system.

Except now it is even more bureaucractic, less democratic and even more obsessed with secrecy than the old health board system (come back all is forgiven!) ever was.

The HSE’s board meets in private, it has no elected representation on it and in effect, the HSE decides itself whether system failures or adverse clinical events in its hospitals (and there have been quite a few) should be subject to independent inquiry.

It polices the service it provides and strictly controls how much information the taxpayer who pays for it should get about it.

For journalists, attempting to extract information from the health executive behemoth can be a frustrating experience, despite its big spend on communications.

I am still waiting, some months after asking the question, for an explanation to as to why outpatient waiting lists stretch to six years or more, let alone confirmation of how many people are actually on outpatient waiting lists.

Luckily, the Comptroller and Auditor General recently broke through this wall of silence and provided us with this figure. It’s 175,000 by the way. No wonder the HSE didn’t want to tell us!

The HSE also has a strange notion of what Freedom of Information actually means. I was recently told that some fairly routine information could not be released as it might have “industrial relations” implications.

In other words, some people might go on strike if some correspondence (with names and job titles removed) was released about a major patient safety issue.

I am waiting three to four months for responses from health officials to FOI requests on what current hospital mortality rates are and on the co-located hospitals project.  With regard to the former, I was initially told that the HSE does not have hospital mortality rates!

Imagine, the hospital service claims not to know what the mortality rates among its own patients are. It’s like a hospital saying it doesn’t know how many beds it has or the number of staff it employs.

Then again, maybe hospitals don’t know how many beds they have. It must be hard to keep track given the volume of bed closures at the moment.

Of course the HSE does know what its hospital mortality rates are. It just wasn’t in a big hurry to reveal them. I’m still waiting for these figures by the way.

Now (and beware, this is the bit where I must provide some “balance”), most reasonable people (ie, me) would have been willing to give those running the HSE a chance. They are doing a very difficult job.

Indeed one is occasionally tempted to write a “good news” story to show that (shock horror) the system is actually working quite well in some places. For example, Wexford General Hospital has contributed to a reduction in the number of hospital infections through an innovative surveillance project.

Primary care teams are actually being set up in some areas and some impressive primary care centres are being put in place (albeit slowly and nearly a decade after they were promised).

Good. A warm glow has started to descend. Perhaps the HSE isn’t so bad after all. You even start to overcome your own self-loathing issues.

Then you read this, courtesy of the Sunday Tribune, and your inner warmth starts to fade rapidly:

“The HSE has confirmed it is in informal talks with one of the country's leading security groups to stop the leaking of confidential documents by its staff.

“The HSE has opened negotiations with Risk Management Ireland (RMI) after senior management expressed concern that confidential internal documents are being regularly released to journalists.

“HSE national communications director Paul Connors said: ‘we are very conscious of the security of our documents in that there would be files on negotiations between ourselves and unions which, if leaked, could lead to major embarrassment and upset.’

Oh dear. It’s enough to make a reptile’s blood boil.

This seems to be one of those “defining moment” type things. You know, St Paul, Damascus and all that.

For there comes a time in the life of any dysfunctional organisation when a memo should be sent to all staff politely requesting that the last person out of here should switch off the lights.

Having of course, entered into the necessary demarcation negotiations with with those entrusted with light-switching duties etc.

In other words, if this security move is the best thing the HSE can come up with during ”challenging” times, then perhaps they should just pack up and go home, go back to the drawing board, sling their hook ... (insert cliché as appropriate).

Put simply (I know, I’m taking a long time to get the the point, but rage has rendered me inarticulate) when you, as an organisation, start acting more like the KGB than the HSE, perhaps it’s time for a period of serious self-reflection.

The Tribune quotes the HSE as stating that documents, from, for example, industrial relations talks, could if leaked, cause major embarrassment and upset. One can almost hear the faint tones of the world’s smallest violin playing in the background.

So what was the embarrassingly seismic information that has actually been “leaked” to the media?

Er…that the HSE, at a time of financial difficulty, was planning to cut staff numbers and seek redeployment of other staff. “The confidential information was issued only to top HSE managers", but subsequently, wait for it …"appeared in the national press.”

One hesitates to use the timeworn phrase "the last time I looked", but I think it's safe to say that we are indeed still living in a democracy, although the HSE mightn't readily agree.

The HSE, apparently didn’t want anyone to know about this staffing proposal, although it was planning it. It was, apparently, to remain a secret forever buried in the vault of one of those many nice buildings the HSE currently occupies.

Now this was certainly a good story for the journalist who got it at the time, but in terms of this leak necessitating a plan to hire a security firm set up by a group of former army officers and senior Gardai, one has to question the HSE’s grip on reality.

The other leak cited as necessitating the HSE’s borrowing the plot of a John le Carre novel was when a letter from a hospital was released warning about cutbacks affecting its ability to operate cancer services.

Again, after you’ve administered the smelling salts, you have to ask whether the HSE subscribes to the theory that if a tree falls in an empty forest it doesn’t make any noise.

In other words, if nobody, or hardly anybody, gets to know about something bad, it hasn’t actually happened.

Another pertinent issue here is the general question of who leaks information and why information is leaked at specific times.

It is often the case, (and we're not saying that this applied in the cases quoted above...your honour) that the more controversial the proposal, the more likely it is to be leaked in advance as a “kite-flying’ exercise to take the sting out of something that’s bound to be unpopular.

Many organisations in the health service have over the years railed against "leaks" to the media. I cannot, however, recall any specific "leaks" that had major ramifications for the efficient running of the health service.

Rather, the "leaks" actually tell people what's going on. Bit of a weird concept, isn't it?

A more obvious issue is how the HSE can countenance spending money on calling in the secret service in straitened financial times. Does it feel it’s not getting enough flak already about the millions it spends on consultancies and advisers?

The HSE, in the Tribune article, cites the defence forces as having more robust security systems in terms of confidential information than the HSE.

Now, most reasonable people (ie, me again) would argue that the defence forces could perhaps justify such robust risk management systems, as some of the information they might deal with would have national security implications if released.

But not so the HSE, unless it’s busy buying weapons-grade plutonium when it’s not spinning about how wonderful the health services are.

Then again, perhaps all this "hiring a security firm" business is simply more spin.

The Irish public has a stubborn tendency to stick to its eccentric belief that it would from time to time simply like to know what is going on in the health service it pays for and not have to rely on media “leaks” or FOI requests.

The US newspaper tycoon William Randolph Hearst once said: ’News is something somebody doesn’t want printed; all else is advertising.” (I’ve always wanted to use that one!)


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