Address by An Tánaiste and Minister for Health and Children, Mary Harney, T.D. to the Annual General Meeting of the Irish Hospital Consultants’ Association

Thank you for you invitation to address your association again this year.

I am very pleased to be here in the wake of your decision to accept my invitation to enter talks on a new, improved and reformed common contract. This is certainly the best news I’ve heard this week. It’s a very positive development.

Of course, from patients’ point of view, it will be the result of the talks rather than the holding of talks that is most important. That is why we have a shared imperative to have businesslike talks in a short timeframe. We plan to recruit hundreds of new consultants and the sooner we can do so on a new contract, the better.

I want to speak this evening about leadership and optimism for our health services.

First, however, I would offer some reflections on some issues of the week.

This has been a week when criticism of the health system reached a crescendo.

Some of the criticism is justified, because there’s one inescapable fact, that the old health board system of governance and management of health simply did not work. The health board system, as it evolved over three decades, became a myriad of confusion, inconsistency and incoherence.

Yes, it succeeded in developing thousands of different work practices; it succeeded in creating hundreds of different grades, and it succeeded in holding hundreds of meetings around the country.

But it failed to enforce financial accountability, it failed to provide clear and timely decision-making and it failed, most of all, in the central purpose of health care practice and management: to put patients first.

At the end of this week, I am more convinced than ever that we did the right thing in abolishing the health board system and replacing it with one single health service executive. This is an enabler of change and reform, not an end in itself.

I am also convinced that it was right to give maximum financial accountability to the Chief Executive of the HSE. Prof. Brendan Drumm has made an excellent start in his new role and the events this week illustrate, I believe, that it is entirely right to give financial accountability and control to the person who also has management responsibility.

I am confident we are beginning to see the new HSE governance of health work and work well. It’s effective, it’s responsive, it’s businesslike.

I am very hopeful that we now have all the building blocks and the tools ready to achieve reform and progress that will make a visible difference in the eyes of patients. And your decision this weekend contributes greatly. Now it’s time to get working, of course, working on reform, on the new contract, on coherence in services, on better financial management.

Leadership in health

I am very hopeful and optimistic about health care in our country.

Sometimes it seems that the biggest secret in our country is just how good health care actually is, right now. Patient satisfaction with the care they receive is consistently very high. If we went through every specialty, we would see evidence of progress. We can all agree there will always be more to do.

For example, we are making tremendous progress in cancer care, in every part of cancer care. And the results are clear: more people are being treated, and more people are being treated successfully. More people are surviving cancer. In cardiac care, we have trebled the number of certain heart operations. We have more than 100 more cardiac specialists now than 8 years ago.

In that context, it can seem strange, especially to visitors to our country, that health is an area where there is an extraordinary amount of negativity.

Let me give you some analogies.

There are thousands of people working in banking in Ireland. Imagine if the consistent message from them was, ‘banking is great, if it wasn’t for the banks’. Now there have been some failures on the part of banks and justifiable criticism, but what would we think, as customers, if every time we went near our bank, everyone, from the porter to the tellers, to the branch mangers, the marketing director, the finance director and the managing director said, ‘banking is great, if it wasn’t for the banks’. Wouldn’t we think this was a strange bank? Wouldn’t our confidence be somewhat dented in the safety of our deposits?

Or how would we feel when we boarded a plane if the pilot said, ‘Good morning ladies and gentlemen, welcome on board, and might I comment that aviation is terribly badly managed, safety issues are routinely ignored, and the engines do fail?’ And the cabin crew then told you not to pay any heed to the pilot?

How many surgeons would illustrate a procedure for their patients by talking only about what could go wrong, about all the medical mishaps or malpractice cases that had occurred around the world in this area?

What would it say to patients if we said, ‘medical care is great, if it wasn’t for the hospitals’?

Confidence is absolutely vital in health care, as it is in our country. It is not a matter of pretending that there are no issues, problems or challenges. But it is about demonstrating that we have a great deal going for us, and we can sensibly and professionally address the problems that do exist.

As a country, we used not have very much confidence in ourselves. Twenty years ago, the country was in a very bad state economically. And there was a tendency almost to revel in how bad things were. ‘A nation of knockers’ was the phrase people used.

We have grown out of that in terms of economic performance. We went beyond knocking and did something about it.

There is a great confidence now, among ourselves, about what we can do, what our potential is, how ambitious we can really be.

But the old tendency is still there and I wonder if it is not beginning to make a comeback.

For example, we are told the entire country is a rip-off, and yet we know that employment is growing tremendously, wages are up far more than inflation, personal taxes are far lower than they were in the 1990s, thousands of people want to come to live and work here, rather than our people being forced to emigrate.

Could it be true that every country in Europe and the world believes we are a success, except Ireland?

This tendency to see and say the worst, to the exclusion of all that is good, all that works, and all that our potential holds, is rather pronounced in health care.

With the economy, our own lack of confidence was one factor that held us back for too long. And just as with the economy, it takes leadership to instill confidence.

That’s a particularly important role I see for consultants, who are clinical leaders in health care.

You know better than most all the positive things about health care in our country. You know about the cures that are currently being administered and about the exciting potential for new cures and treatments. You know about how clinical practice is developing with brilliant people leading the way in specialties and sub-specialties.

I would encourage you to act with confidence, to speak with confidence, to engender confidence. Bring forward innovation and ideas. Help others to do the same. If the leaders let themselves be daunted by the clear challenges, what can we expect others to feel? What can we expect patients to feel?

Let us not just accept reform and change, but lead reform and change. The focus this weekend is about contract talks. But leading reform, innovation and progress is about a lot more than negotiating contract details. As consultants you have tremendous potential to lead change, innovation and progress. You have a great potential to instill confidence among staff and the public in health care, in reform and innovation.

We showed with the economy that we all had to work together to lift ourselves out of the doldrums and achieve our true potential. We still do. And the same goes for health. We need every group and every interest to move together, to get out the trenches and see how much more we can achieve working for reform together.

So I invite you to be leaders for change and reform.

I invite you to demonstrate openly the leadership that will encourage people to work together for the greater good of all, most of all for patients.

I invite to you use your standing and leadership to create the sort of confidence that can build a world class health care in our country to go alongside a world class economy.