Drumm's anger at HSE reform veto

HSE CEO Prof Brendan Drumm warned the HSE board last April that the beleaguered health executive was at a "tipping point" and faced a crisis, after the board vetoed key components of his plans for HSE reform.

He also wrote to Department of Health Secretary General Michael Scanlan expressing frustration at the pace at which HSE reforms were being implemented.

The CEO at the time was in the midst of a row with the HSE board over plans for major HSE corporate restructuring and faced increasing pressures over the HSE's budgetary position.

Correspondence released to irishhealth.com under FOI reveal the tensions that existed between the HSE CEO and the HSE Board and its Chairman, as a power struggle emerged over who should direct HSE policy at a crucial stage in its development and what this policy should be.

In the end, the clash between the CEO and the board led to a watered-down version of what had originally had been a fairly radical plan for HSE management reform.

The policy row had apparently been defused by April. In September, Prof Drumm confirmed on national radio that he would not be seeking a second five-year term as CEO.

The CEO wrote to HSE Chairman Liam Downey on April 8 last, just over a week after the HSE board had vetoed a major part of Prof Drumm's plan for a corporate revamp designed to make the much-criticised HSE more efficient, more responsive to local needs and to help progress the HSE's "transformation process", including hospital reconfiguration.

In a surprise move, the HSE board on March 30 had decided not to go ahead with the plan to fill key new national director posts in charge of Operations, Planning & Performance and Quality & Clinical Care, all of which had already been advertised.

The board cited current financial pressures, lack of clarity in relation to redundancy/early retirement arrangements and the new moratorium on public sector recruitment and promotion as the main reasons for not going ahead with filling the key posts.

However, the HSE board had at that stage already clashed with Prof Drumm over who had the final say in the filling of the key director of operations post.

In his letter to Mr Downey on April 8, a clearly frustrated Brendan Drumm said: "there is an urgent need for me to provide stability within the organisation in the area of operational delivery and a need to progress the development of integrated care." (Between hospital and primary/community care).

In light of the HSE board's decision not to fill the director posts, Prof Drumm told Mr Downey he was putting in place an interim operational arrangement to bring stability within the HSE and "to provide the clarity that is essential at this time."

He said the interim arrangement would in turn allow time for longer term proposals for HSE reform to be developed and proposed the appointment of a lead clinical director, the establishment of four regional areas to provide more local devolution of services and to create a national head of services.

Prof Drumm said there was an urgency to put in place stronger regional capacity in order to deal with the "unprecedented challenges" the HSE faced, and to give rapid effect to this, the HSE needed to move to regional arrangements with the HSE's four existing administrative areas and the establishment of a post of regional director on a temporary basis.

The previous reform plan had proposed six new regional areas with greater local powers, whereas the four operational areas subsequently proposed by Prof Drumm already existed on an administrative basis.

In the letter, the CEO refers to the "tipping point" the HSE faced  as a result of "substantial momentum" which existed regarding core elements of the integrated care model.

He also warned Liam Downey that the HSE faced "unprecedented financial pressures which demand robust management in concert with senior clinicians to address fundamental changes in healthcare delivery."

"We must now have our most experienced managers and clinicians address these national crises with absolute dedication and rigour," Prof Drumm said.

The CEO said he had reflected "very seriously" on the board's decision not to go ahead with the director appointments and its implications for the HSE at that point.

He said he had decided to draw up the interim reorganisation plan in the best interests of services and patient care.

Prof Drumm also wrote to Department of Health Secretary General Michael Scanlan on April 14. He told Mr Scanlan:"there is an urgent need for us to implement internal changes in the HSE at this point in time."

The CEO told the Department chief that there was frustration at the pace at which HSE reform was taking place and he asked for his support in moving forward with the necessary reforms.

"The HSE needs to be operating in an environment where there is optimal clarity on accountability because of the huge financial and other challenges that it faces in the present economic environment," Prof Drumm said.

Prof Drumm told Mr Scanlan that the recently-published HIQA report on Ennis Hospital (where breast cancer misdiagnoses had taken place) "confirms our need to have a greater focus on hospital reconfiguration at a national level."

The CEO said under his revised reform plan, there would be a manager in charge of services in each of the four regions and these would report to two national directors who would be reassigned from their present roles in the National Hospitals Office and the primary and community care directorate to work within his office.

One of these managers would be in charge of hospital reconfiguration and the other in charge of ensuring that the four regions are implementing Government policy on health in a standardised way.

HSE Chairman Liam Downey, in a subsequent letter to Prof Drumm on April 20 defended the board's decision not to go ahead with the CEO's original plans, which he said was made for "valid and sound reasons."

Mr Downey referred to a meeting that took place on April 9 between Mr Scanlan, Prof Drumm and members of the HSE board to discuss Prof Drumm's alternative proposals with a view to advancing them.

A subsequent letter from Prof Drumm to Mr Downey on April 22 indicates that agreement in principle on the interim plan was being reached and that the row between Prof Drumm and the HSE board appeared to have been defused.

Later in the year, the HSE announced the appointment of Dr Barry White as national clinical care director and then confirmed that there were to be four new regional operating units.

In addition, it announced that a new integrated services directorate was being set up from the amalgamation of the exiting hospital and primary care directorates under the leadership of the two current national directors.

In Prof Drumm's aborted plan, it had been intended to integrate the two existing directorates under a single director of operations. The issue of filling this post had led to tension between the CEO and the Board.

[Posted: Tue 12/01/2010]