Pandemic showed importance of ‘devolving’ authority to frontline

The recent 18th National Health Summit heard calls for the health service not “to return to type” and to build on “positive” changes during the pandemic. 

“Why was the system agile? It was because the traditional system, which was about the centre having all the authority and the frontline consultant and staff having the accountability and responsibility, well that system shifted overnight,” Dr Gabrielle Colleran, Consultant Paediatric Radiologist and IHCA Vice-President, told the online conference. 

Dr Colleran said the Covid crisis saw some “authority transferred to frontline staff… we designed care pathways, we re-imagined the way we provided care in an agile way”. 

“It really showed us the importance of devolving that authority to the frontline. Because what we saw before is when the control is really central and bureaucratic, it can be really hard to deliver improvements and deliver change. 

“Speaking from a consultant’s perspective, when you have the responsibility and accountability, but you don’t have the authority to issue changes and improve things, that is extremely frustrating and it does lead to burnout and leads to people leaving.” 

In this context Dr Colleran highlighted the importance of the planned six regional health authorities. 

She also said that “some aspects” of the use of telemedicine during the pandemic “really works”. 

However, according to Dr Colleran, bed capacity remained a serious challenge. 

“We in the IHCA say we need around 6,000 new beds,” she said. “Those beds will have to have the appropriate specialists, nursing staff….” She warned we are “careering towards a million people” on waiting lists. 

Dr Sara Burke (PhD), from the Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, told that conference that much of the “universal nature of the response” of the health service to the pandemic was in line with the vision of Sláintecare. 

“We saw a system that responded agilely if not perfectly in all cases,” said Dr Burke. “But it did really well overall. Really important new pathways and trajectories for patients emerged so that they could get better access to care. 

“But I think it is important to take into account the amount of care that wasn’t accessed… we are reaping the downside of that now with those waiting lists in hospitals and also the community.” 

She warned there was “a very real risk that the system reverts to type”. 

“That we go back to doing what we did before rather than spring-boarding on the strengths that we have seen.”