Eilish O'Regan: 'HSE chief will need to call on his best bunker shot as health service sinks further into red'

As a keen golfer, the new chief executive of the HSE Paul Reid knows all about the dismay of ending up in a bunker and the difficulty of getting out of it.

Now that he starts in the €350,000 job of this troubled organisation, that has failed to win the confidence of so many of the public, he will find himself often scrambling to escape the trap.

The former chief executive of Fingal County Council took over yesterday and said his priorities are a safe and quality service, moving to new models of care and strengthening confidence and trust.

His in-tray is already piled high – and that’s just what he knows about. The next unexpected crisis is surely already simmering.

Here are just some he has inherited:

1. Money worries

The HSE received €16bn but is already heavily in the red. It is reining in hospitals which have been hiring staff without an agreed spending plan.

This has led to a pause in recruitment in some areas until June but it may need to be extended. Some staff who got a job offer are finding it has been put on hold.

How will this reconcile with promises to recruit more doctors, nurses and therapy staff?

2. Owning up to mistakes

Senior doctors are to face mandatory open disclosure for serious adverse events.

If something goes wrong they have to tell a patient or relatives. This is more difficult than it seems, and is potentially fraught for some reluctant doctors who fear loss of reputation and litigation.

3 A general election

An election this year or next will be a risky time for the health service. Political priorities can lead to disharmony and difficulty.

Promises can be made in areas like access to drugs and pay without the extra funding to back them up.

The months leading up to the last election saw the emphasis put on keeping a lid on the “shop window” of A&Es and the trolley crisis.

It meant hospitals had to be free as possible but this meant less operations were carried out on waiting list patients.

4 Lengthening queues

The growing waiting list of public patients who need to see a specialist seems to be out of control. Around 11pc of the population are now in the queue for a first appointment with a specialist; waiting for years in some cases.

It is tied to another fence the new chief executive has to jump – how to fill hundreds of consultant vacancies.

Health Minister Simon Harris has promised action in bridging the 30pc pay gap for new recruits but as yet this has not been costed and it is unclear where the money will come from.

5 Gridlocked hospitals

The “winter” trolley crisis now extends into the summer as hospitals face unprecedented patient demand. More beds are on the way but they are slow to roll out.

Headway must be made moving more services to the community as proposed by Sláintecare plan.

On a positive note there are now pay and fee deals agreed with nurses and GPs which should open the way for more reforms.

But the GP service is creaking at the seams in some areas and it remains to be seen how much extra workload they will take on for now.

6 Transparency

The HSE remains too defensive, closed and secretive. If that culture was not so embedded, would the CervicalCheck scandal ever have happened?

Would a journalist have been forced to investigate to reveal the state of Waterford hospital mortuary if it had been released by the HSE under freedom of information?

Nobody ever seems to be held to account.

It’s always “a systems failure” that’s at fault – a phrase the newly installed chief should instantly ban.

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