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Navigating Navigating the Political the Political Maze of Maze of Healthcare Healthcare

Eilish McAuliffeEilish McAuliffe, Senior Lecturer/Director, Health Policy and , Senior Lecturer/Director, Health Policy and Management, Trinity College Dublin.Management, Trinity College Dublin.Frank AhernFrank Ahern, Former Assistant Secretary, Department of Health & , Former Assistant Secretary, Department of Health & ChildrenChildrenPart-time lecturer, Health Policy and Management, Trinity College Dublin. Part-time lecturer, Health Policy and Management, Trinity College Dublin. Fergus O FerrallFergus O Ferrall, Director, Adelaide Society & Part-time lecturer, Health , Director, Adelaide Society & Part-time lecturer, Health Policy and Management, Trinity College DublinPolicy and Management, Trinity College Dublin

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The BookThe BookContributors:Contributors:Michael Kelly, Chairman of the Higher Education Authority and Former Secretary Michael Kelly, Chairman of the Higher Education Authority and Former Secretary

General,General,Department of Health and ChildrenDepartment of Health and ChildrenJohn Owens, Chairman of the Mental Health Commission and Consultant PsychiatristJohn Owens, Chairman of the Mental Health Commission and Consultant Psychiatrist Ruth Barrington, Former Chief Executive, Health Research Board Ruth Barrington, Former Chief Executive, Health Research Board Fenton Howell, Public Health Specialist, HSE North East and Shane Allwright, Fenton Howell, Public Health Specialist, HSE North East and Shane Allwright,

AssociateAssociateProfessor, Department of Public Health and Primary Care, Trinity CollegeProfessor, Department of Public Health and Primary Care, Trinity CollegeFrank Ahern, Former Assistant Secretary, Department of Health and ChildrenFrank Ahern, Former Assistant Secretary, Department of Health and ChildrenMatt Merrigan, National Industrial Secretary, SIPTUMatt Merrigan, National Industrial Secretary, SIPTUAnne Scott, Head of the School of Nursing and Deputy President of Dublin City Anne Scott, Head of the School of Nursing and Deputy President of Dublin City

UniversityUniversityAileen O Meara, Independent journalist and media consultant, formerly RTE’s Chief Aileen O Meara, Independent journalist and media consultant, formerly RTE’s Chief

healthhealthcorrespondentcorrespondentFergus O Ferrall, Chairman of the Adelaide SocietyFergus O Ferrall, Chairman of the Adelaide Society

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Content of workshopContent of workshop• The critical elements of health service The critical elements of health service

reformreform– The practice of reforming in a politicized The practice of reforming in a politicized

environmentenvironment• Story of reforming from the inside out - Frank AhernStory of reforming from the inside out - Frank Ahern• Story of reforming from the outside in – Fergus O Story of reforming from the outside in – Fergus O

FerrallFerrall

• Navigating the political mazeNavigating the political maze– Common characteristics of successful Common characteristics of successful

navigatorsnavigators

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Critical elements of Critical elements of reformreform

• timingtiming• financial viabilityfinancial viability• political will and leadershippolitical will and leadership• strategic alliancesstrategic alliances• public supportpublic support• well-managed processwell-managed process• technical infrastructure and capacity.technical infrastructure and capacity.

• Saltman & Figueras (1997: 259)Saltman & Figueras (1997: 259)

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TimingTiming• New mood for strategic thinkingNew mood for strategic thinking• Led to several national strategies Led to several national strategies

and policy documentsand policy documents• National Health Strategy (2001)National Health Strategy (2001)• DoHC move away from operational DoHC move away from operational

management – Health Services management – Health Services Executive (2005)Executive (2005)

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TimingTiming• Busy period of policy formulation in Busy period of policy formulation in

healthcarehealthcare– Long-term perspectiveLong-term perspective

• Policy implementation Policy implementation – short-termshort-term– Influenced by political cycleInfluenced by political cycle– Eg. Priority of health strategy Eg. Priority of health strategy

diminished with changing Ministerdiminished with changing Minister

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Financial viabilityFinancial viability• National Health Strategy funding National Health Strategy funding

– Not supported by Dept of FinanceNot supported by Dept of Finance• De-institutionalisation of mental De-institutionalisation of mental

health patientshealth patients– Without additional financesWithout additional finances

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Strategic alliancesStrategic alliances• Smoking BanSmoking Ban

– Strategic alliances to counter the anti-Strategic alliances to counter the anti-ban alcohol industryban alcohol industry

• Development of Nursing ProfessionDevelopment of Nursing Profession– Strategic alliances needed to transfer to Strategic alliances needed to transfer to

university environmentuniversity environment• Health Services National Health Services National

PartnershipPartnership – Reduction in strike actionReduction in strike action

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Public supportPublic support• Unwillingness to engage with the public Unwillingness to engage with the public

has led to difficulties implementing has led to difficulties implementing hospital reconfigurationhospital reconfiguration

• Democratic deficit has had many negative Democratic deficit has had many negative effects on the nature and progress of effects on the nature and progress of healthcare reformhealthcare reform

• Poor relationships with media have led to Poor relationships with media have led to focus on “bad news” stories creating ever-focus on “bad news” stories creating ever-widening divide between the public and widening divide between the public and the healthcare systemthe healthcare system

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The practice of reforming The practice of reforming in a politicized environmentin a politicized environment

– Story of reforming from the inside out - Story of reforming from the inside out - Frank AhernFrank Ahern

– Story of reforming from the outside in – Story of reforming from the outside in – Fergus O FerrallFergus O Ferrall