Gino Kenny warns HSE unsustainable, cites burnout and fragmentation

Thanks, Mr Cairns. Mr Cairns, there is a perception out in the public that the HSE is overly bureaucratic and too many managers and not enough delivery. Do you believe that perception is true? Mr Cairns, I would say that is the perception that there are too many managers, but I think we have to be careful about that as well. Most clinical teams need non-clinical people to make them function. If you are looking at, say, for instance, organising SLAs with multiple organisations, you need people with expertise in that as well. So there is a real, you know, healthcare management is tough and it is a difficult gig. And I think for most of, there is generally, and because we set up the system the way it is, it just makes almost an impossible job for pretty much everybody in the system. And there is, you know, where you can see the system, it is firefighting and it is crisis management all the time. And we have not made it a good place for people to work. And unless we, and this is why we mentioned the whole workforce and culture issue in our advice, that we have to address this in the round. That the, you know, whether your role is to be an accountant or your role is to be the porter at the front door of a hospital or your role is the practice nurse in a GP's practice or you are the GP or you are the consultant or you are the junior doctor or whatever. That there's multiple roles in a complex system. You need all of these people, the manager of a hospital, the manager of a, of a CHO and so on. So I think it's, it's probably, well, it might be the perception. I don't think it, it brings us forward that much. But you understand. Oh yeah. How that perception of prevails. Cause when people, you know, try to access healthcare. Yeah. And it's simply not there. I know. Yeah. It's the most frustrating thing. Yeah. And I, I, you know, you're absolutely right. And I think when people, when people get into care, they find this is, this is really good, generally speaking, people have great experience, but it's the access to it. And, and, you know, people's trust then erodes. And, you know, a lot of people are, are really worried about if I have to go into an ED department, am I going to be waiting for 24 hours on a chair or, you know, what's going to happen to me. And for the staff who are watching that, it is incredibly difficult. And I'd say one of the big issues that we have, particularly after COVID is the, the stress of working in healthcare is so significant. And the last two years and two and a half years have really just amplified that, but it existed before this as well, that we've set up the system in such a fragmented, poorly governed way that for people who are working in healthcare, they're trying to do their best. And I see, and I, this is at every level, I can see it within the department, within the HC centre, right out into the frontline, that people have, have really kind of, I won't say burnt out, but there is a significant burnout element to it. And this is why we have to put such huge focus on this, because this is not sustainable. Like it's, it's not that this is a nice thing to do. We cannot go on like this. And actually it is, and it probably is important for me to say it as well, that the, the cross party support that Sláinte Care brought in is critical to this, because having political support, joined up political support for this is absolutely necessary. And I think it will give people confidence out there that if there is that kind of support, if there's coherence then with the department, with the HSE, with the frontline, that, that, that people will have some hope that this is going to improve. Yeah. Because that's really big. I agree. And just in relation to the last two and a half years, it's, has been beyond challenging in relation to the pandemic and other factors. And I think a lot of people that work in the health service are really being, are pinned to the collar in relation to everything that's going on. And just in relation to your statement in relation to, and it's a breath of fresh air, I think, kind of your critique in relation to our health service. I think it's how it can be corrected. You use words like joined up integrated approach, service planning, delivery and empowerment, deliver that care. Is that not happening at the moment? Because if that's not happening at the moment, one gets very concerned. To be honest, I don't think it's possible for it to happen at the moment. I mean, when you think about the way the system is set up, we have all of the budgets separated out. We have GPs operating separate and, you know, not necessarily with access to diagnostics. I know that has, has improved and there's more diagnostics available. But, you know, I wouldn't like to be a GP without immediate access to diagnostics and the risks that creates for GPs and for, for patients. So the way I think this is why this is quite fundamental, the way we've organised our health service, it's like we're playing a game of football. And literally, first of all, we haven't even marked out the pitch. We, we, and every single player on the pitch is, is reporting to somebody different. They're not reporting to the manager. They don't even know. So, so, so, so, and then we expect to go out and, and by the way, we should have 15 players on the pitch, but we only have 10 on the pitch. And we're expected to play a game. So I think when we, when we understand just how impossible it is, it has to be the drive for saying this just is utterly unsustainable and has to change. Yeah. Yeah. And I, I kind of hate using the D word, but it sounds like it. And the pitcher that you paid paint does absolute dysfunctional dysfunction at the heart of our health service in relation to how it's managed. You, obviously you make the parallel between, you know, the football parallel. Yeah. I think, I think the, the problem is not so much how it's managed. It's, it's just the way it's been set up is just has led to this. And I have huge sympathy for people who are trying to do their best to manage in this. So, you know, imagine you're the manager on the side of the pitch and you're doing your best to put some shape on this. But meanwhile, everybody is reporting in a different, in a different way. And do you believe with the, the RHA is if they were kind of constituted right now, the kind of, that kind of dysfunction would address them issues around kind of that, you know, that parallel between, you know, what you said? Yeah. I mean, I think the RHAs have to address that. And I think it's bringing it local because at the end of the day, joint up care only means something. If it, if it happens to individual patients, like you got to do it at the system level. But at the end of the day that, you know, that you go to your GP, there's a connection between that and the diagnostics and the hospital and the community and so on. And that doesn't happen unless you plan for it to happen. And, and the only people who can plan for that particular thing to happen are the people who are doing that. So the RHAs in themselves don't solve it, but they create the means and the approach that will solve it. Okay. And, and that's why we need to get on that path now. And I think in fairness as well, I think the, you know, at the HSE center, the kind of things that they should be spending their time on. They're just, they just can't spend their time on that. Those strategic framework, you know, the overall programmatic approach and accountability because they're sucked down. Everybody is operating two or three layers below where they should be. And then, so we can be critical and, and so on, but it's, it's actually, it's just as impossible for them. And, and I think it has, you know, impacted on the department in the past as well. So I think we have to be. And this sounds like it's going to take a considerable amount of time to correct. Yeah. I'd love to be able to say that this is something that will be done tomorrow, but like we've been building this for the last 20 years nearly. And I think it's going to take time, but I, I also do think that if people genuinely felt that there was something really significant and serious going to happen, there is huge support out there among frontline staff, among hospital managers and so on. And some of it will be, you know, difficult enough and so on, but there is huge support. So I think you might get, I think you will get a lot of acceleration in it. Yeah. In relation to the RHAs, the six, where will they be kind of geographically placed? Yeah. The, the, do you mean the, the actual, the, the boundaries? Yeah. Yeah. I mean, there is a map that has, has been, okay. I mean, you know, that's available from the. Okay. That's yeah. That, that maps them out. Yeah. Just, just in relation to Eastern health boards and health board and so forth. Yeah. What difference? Yeah. Um, cause when I was growing up, that was kind of a small model of healthcare and so forth. And obviously then there's a different kind of evolution of that now. Um, and obviously some people kind of are quite nostalgic about Eastern health boards and, and all that kind of stuff. And, um, how different would that model be to the model that you're in, in this, your statement? Yeah, I think the kind of fundamental difference for me is that the health boards really did have that autonomy, but it led to huge variability in the quality of care and outcomes and so on. So it depended on where you lived and, you know, what your health board and it depended on political issues as well. Mm. So I think the critical thing in this and, and, and this is why I think the HC centre has a critical role to play in this. We have to have national standards. We have to say, look, we're not going to have multiple different ways of, of delivering cancer care. We're going to have a model, which is a national model, which looks at prevention and treatment and so on, which makes decisions about, look, some facilities just are not, not fit for delivering certain types of care. So I think the big, the big difference for me is that we're, um, we're saying yes, local ownership and joined up care. That's critical, but working with it within national standards. And then the other thing is that there is a, has to be real strong accountability. So that if an RHA is responsible for what it is they're responsible for, they make the decisions that they need to make, they then have to be held to account for that. Thank you very much. Thank you, yeah. Thank you. Thank you. You