DCU Professor gives critical analysis of the Health Service in Ireland

Prof Anthony Staines, DCU School of Nursing

Prof Anthony Staines, DCU School of Nursing has said the Health Service Executive is lacking both political and media support, making its job more difficult – and he strongly rejects calls for its abolition.

Prof Staines was also heavily critical of the roll out of private hospital co-location on the sites of public hospitals. He said the plan “has apparently been evaluated by somebody – the evaluation is secret, as is the scope of the evaluation. It restricts the future development of public hospitals, many of which are on very constrained sites, consuming enormous amounts of HSE and hospital management time.”

Hospital co-location is a “further heavy public subsidy to the private health care sector”, he said and the UK experience of their rather different Public Private Project experiment “is not very positive.”

The Professor in Health Systems Research made the comments at his inaugural lecture on Information Systems in Health Planning at DCU on Monday 26 May, where he was introduced by DCU President, Professor Ferdinand von Prondzynski, and DCU Chancellor, David Byrne.

Chancellor Byrne emphasised the importance of Professor Staines’ work in the area of health planning. In his brief address, Chancellor Byrne made reference to the resolution passed by the World Health Assembly of the WHO on 24 May 2008 to tackle what are now the leading threats to global human health: non-communicable diseases. These diseases - particularly cardiovascular diseases, diabetes, cancers and chronic respiratory diseases - caused 60% of all deaths globally in 2005 (estimated at 35 million deaths). Low and middle income countries are the worst affected by these diseases which are largely preventable by modifying four common risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

Prof Staines believes health management structure is of little or no importance, though the HSE is “seriously hampered by its origins, and the time it has been given to change.” The HSE was made by “slamming together 11 organisations, some of which were notably dysfunctional.”

“Structural change, as the HSE demonstrates, often paralyses an organisation and its staff for several years. The Minister for Health Mary Harney set it up in haste in 2005. There is no sign that much thought was put into setting it up at the time”, he said.

Prof Staines said the HSE was far from perfect, it faces many problems, not least a growing chorus of calls for its abolition. Abolishing the HSE, he says would spell disaster. The health service suffers from being used as a “political football.”

“It must be stoutly resisted as the experience with the NHS in the UK found that such structural change can often be counter-productive and paralyse staff for several years while the changes take place. Abolishing it would be an excuse to further postpone hard decisions”.

Professor Staines said that whatever happens, the same problems will need to be solved. “We have a poor health service, delivered by skilled, dedicated and hard-working people, we have a complex three-tiered service, which is often brutally unfair, quite good at acute illness, truly awful at chronic illness.”

The public service ethos, according to Prof Staines, encourages obedience and discourages rocking the boat. “This can all be fixed he said, “but only by reconfiguring what the staff do, not by shuffling the headed notepaper around.” He also said changes need to happen at senior level within the HSE.

“Many of our public services, not just the HSE, are inward looking, defensive and more focussed on their interests than their clients’ interests.”

During an interview on RTE’s Drivetime programme, he revealed there are more GPs retiring every year in Ireland than there are setting up – and primary care is top of his list of issues to be confronted in improving the health services. He believes the shortage of GPs is a serious hindrance and set back to primary care and front line services in this country.

Professor Staines was also strongly critical of the information systems in the health service. “Ireland” he said, “has state of the art health IT systems – circa 1970.” He said the systems are inadequate for management, inadequate for monitoring and quality control, and inadequate for planning.”

Dealing with the controversial issue of cervical cancer screening he asserted that at least 80 per cent of the 80 deaths from the disease in 2005 were preventable. Screening has been available in almost all other developed countries for between 20 and 40 years – and not in Ireland, because of political inaction, and public and media apathy which allowed this to happen.

Also, funding for early intensive intervention for children with autism would be “actually profitable – it pays for itself” because of savings in long term care costs for perhaps 60 years.

Anthony Staines took up his position as Professor of Health Systems Research at the DCU School of Nursing in August 2007.

Click here to view Prof Staine's lecture in DCU School of Nursing in August 2007

To listen to a radio interview with Prof Anthony Staines conducted on RTE's Drivetime. See also The Irish Times' Healthplus article, "Media Ignores Public's Positive Perception of HSE".