Health reforms present an opportunity not to be missed


26 Jun 2003

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With all the hullabaloo about the health services and what’s increasingly being seen as ‘expensive care’ it will be interesting to see what will come out of the two or three reports that are about to be released into the world. It will be even more interesting to see the reaction of the Government and the health fraternity to what they contain.

I imagine there’ll be general agreement that, well, maybe having 10 or 11 health boards is a bit over the top, especially when you consider that the total population is somewhere in the region of four million — something akin to the population of Manchester. I imagine too that great play will be made on the need to use technology to streamline what the authorities do and to drive down the ever-burgeoning cost of running this essential public service. This, of course, is what you would expect. Or is it? Technology has brought the potential to completely review and re-build support structures (organisations and networks of processes) for ‘corporate’ activities such as service delivery and back-office processing. The secret is that you start with the desired outcome and work back to the required structure, not the other way round. For some reasonably healthy organisations this is difficult to justify because of the ‘devil you know’ syndrome. For basket cases, however, it’s an absolute must.

The interesting thing about the way technologies have been developing is that they have created new opportunities to achieve results in totally new ways. For delivering government services, we see the emergence of information sites such as this Government’s Oasis and Basis sites. And we can expect to see the arrival of even more interactive services to join the likes of the Revenue On-Line Service when the much-touted Public Services Broker appears later this year — or is it next year (it’s hard to keep track of the shifting dates). But that’s only a part of the story and really more about appearances than real substance in terms of cost reduction. It hasn’t yet impacted on the amount of duplication that is going on across the public service.

Big business tends to have a sharp focus on the cost of operating and rarely misses an opportunity to smarten the way it works because of the impact on the bottom line. You’ll tend to find that they make rational decisions on big investments and they look for greater productivity in terms of lower costs and higher revenues. Well, the smart ones do anyway. So, we have the likes of Oracle, which can centralise some of its common activities, such as financial transaction processing. It does this by making sure that all of its operations stick to the same rules and processes and then make them, whatever their location, use the one ‘central’ processing facility. This makes loads of sense because of the well-tried concept of economies of scale. But it even goes beyond this, because some companies completely rebuild their structures to support a particular customer service or production process. And the internet age has brought with it the concept of customisation or letting the customer ‘configure’ what they want in a self-service way, just like Dell as it happens.

The interesting thing about governments these days is that they have espoused this private sector notion of customer service and putting the customer at the centre. The danger, though, is that they start using technology to conceal all the complexity and duplication that comes with the type of bureaucracy we have. And our bureaucracy is really a collection of independent little bureaucracies, flying together in loose formation, with little regard to how they might be re-inventing costly wheels at the expense of the increasingly enlightened taxpayer.

Turning back to the pending reports on the health services — wouldn’t it be marvellous if someone were to shout “stop, let’s start all over again!” Not the existing people, mind you, because there’s always the unfortunate possibility that they’ll let their personal loyalties and interests influence the way they see things. That’s only natural after all. But when you look at the transformations that have taken place in the big corporates (and I can hear all those cries of ‘but we’re not the private sector’), they had to completely rethink what they’re about. So why can’t we?

There is a view that because of our extremely slow emergence as an economy, Ireland skipped from being an agrarian society straight to being a service economy. In other words, we leapfrogged over the industrial age in a way. This happens all the time. Europe leapfrogged the US in mobile telephony (for a while anyway). So, is there now an opportunity for us to leapfrog to a new type of health service (oops, I almost said ‘bureaucracy’ there!) that is really based on the needs of clients and not just in a reactive sense? Is it not possible for the Government to call a halt — even a short pause — and see if there is a better way of serving the citizen in service provision and using taxpayers’ money. In fact, I’d go further and say that it is a golden opportunity to do something really positive. I say this because things can hardly be as bad again or least I suspect so bad that we’ll have nothing to lose by being bold and imaginative.

Now is not the time for knee jerks. In the calm that follows the storm (and, no doubt, all the defensive rhetoric that will inevitably and understandably follow the publication of the reports), why can’t we turn it into an opportunity to do it really right and create a new trend in serving the citizen?

The healthy option is staring us in the face!

By Syl O’Connor