Opinion

Newton Emerson: Disturbing new low as NHS managers vilified

Newton Emerson

Newton Emerson

Newton Emerson writes a twice-weekly column for The Irish News and is a regular commentator on current affairs on radio and television.

The Western Trust announced last month that emergency general surgery is to be withdrawn from the South West Acute Hospital in Enniskillen
The Western Trust announced last month that emergency general surgery is to be withdrawn from the South West Acute Hospital in Enniskillen The Western Trust announced last month that emergency general surgery is to be withdrawn from the South West Acute Hospital in Enniskillen

Over 1,000 people attended a public meeting in Enniskillen last Friday, organised by the campaign to retain emergency general surgery at the South West Acute Hospital.

It was addressed by councillors and MLAs from the DUP, UUP, SDLP and Sinn Féin, plus independents. At one point, a show of hands was requested for the resignation of Neil Guckian, chief executive of the Western Trust. The whole audience appeared to do so, which is unsurprising, as their political representatives have spent the past month demanding management heads must roll.

A no-confidence motion in the trust’s entire 16-person board, plus a demand for Mr Guckian to resign, was tabled at Fermanagh and Omagh District Council’s full meeting in early November, to be debated this week.

There have also been political statements alleging the trust has engineered the shortage of surgeons in Fermanagh by not putting enough effort into recruitment.

The final straw for the council motion was supposedly a briefing from Mr Guckian in October, which he asked to be held in private without the media. Councillors claimed the chief executive is required to be transparent and accountable.

There is a parish pump pomposity to councils demanding authority over hospitals and this becomes deeply ironic when Stormont parties are involved. In Northern Ireland, uniquely in the UK, councils have no role in the health and social care system. Stormont oversees it all.

Several councils have nevertheless set up health subcommittees to engage with trusts and take part in consultations. Fermanagh and Omagh District Council’s health subcommittee grandly claims Mr Guckian has “a responsibility to ensure” its view “informs and influences the Western Trust’s input into service design and delivery.”

The trust has recognised the council as a ‘stakeholder’ and met the subcommittee often but this is essentially a courtesy. Health managers do not have to endure public grillings by councillors intent on grandstanding and misdirection.

Mr Guckian robustly defended himself at another council meeting two weeks ago, saying there were legal reasons the October meeting had to be private and this was agreed by the subcommittee.

He noted there had been nothing to officially consult stakeholders on, as at that time no proposal to deal with the recruitment shortage had been approved by Stormont ministers or senior civil servants. So the trust could only meet the council for a doubly courteous “pre-consultation”.

Mr Guckian added trust managers are having to deal with councillors spreading “misinformation” and “completely false information”, such as claiming surgeons in Altnagelvin are willing to provide emergency rota cover in Enniskillen - a logistical impossibility.

The council’s actions “hinder us from working together to advocate for services,” Mr Guckian concluded.

It is far worse than that. The behaviour of parties at council level relates directly to their failure at Stormont.

They will not deliver health reforms they know are essential, for fear of short-term local unpopularity. When their neglect causes services to fail, they elbow their way into protests and campaigns against the consequences of their own inaction. As a final insult, they direct public anger towards the managers they have left to clean up the political mess.

However, events in Fermanagh mark a disturbing new low in the vilification of individuals. The Western Trust board is not some dark clique of scheming fat cats: two-thirds are career medics and administrators, the rest are non-executive directors - experienced professionals giving their time for a whopping £8,000 a year.

The cross-community consensus among the parties attacking the board is no cause for celebration. Surgery in Enniskillen collapsed under a UUP health minister, then Stormont collapsed under a DUP boycott. Sinn Féin and the SDLP will join unionists to condemn the trust instead because nationalist parties caused the same problems in the past and presumably envisage doing so again.

Of course, health managers should never be beyond criticism. The NHS has fundamental problems with transparency and accountability but these are just further obvious issues our politicians have failed to address during two decades of devolution. They are not excuses for failing to deliver health reform as well.

Saving public healthcare in Northern Ireland will almost certainly require more autonomy for managers, given the inability of politicians to stand over the necessary decisions. Operational control could be transferred to an arms-length quango, as with the NHS in England, or the organisation could be run under a BBC-type charter.

But how easy will it be to recruit leaders for that task if the Enniskillen meeting is a taste of what they can expect?