1 Navigating the Political Maze of Healthcare Eilish McAuliffe, Senior Lecturer/Director, Health Policy and Management, Trinity College Dublin. Frank Ahern, Former Assistant Secretary, Department of Health & Children Part-time lecturer, Health Policy and Management, Trinity College Dublin. Fergus O Ferrall, Director, Adelaide Society & Part-time lecturer, Health Policy and Management, Trinity College Dublin

2 The Book Contributors: Michael Kelly, Chairman of the Higher Education Authority and Former Secretary General, Department of Health and Children John Owens, Chairman of the Mental Health Commission and Consultant Psychiatrist Ruth Barrington, Former Chief Executive, Health Research Board Fenton Howell, Public Health Specialist, HSE North East and Shane Allwright, Associate Professor, Department of Public Health and Primary Care, Trinity College Frank Ahern, Former Assistant Secretary, Department of Health and Children Matt Merrigan, National Industrial Secretary, SIPTU Anne Scott, Head of the School of Nursing and Deputy President of Dublin City University Aileen O Meara, Independent journalist and media consultant, formerly RTE’s Chief health correspondent Fergus O Ferrall, Chairman of the Adelaide Society

3 Content of workshop The critical elements of health service reformThe critical elements of health service reform –The practice of reforming in a politicized environment 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 FerrallStory of reforming from the outside in – Fergus O Ferrall Navigating the political mazeNavigating the political maze –Common characteristics of successful navigators

4 Critical elements of reform 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)

5 Timing New mood for strategic thinkingNew mood for strategic thinking Led to several national strategies and policy documentsLed to several national strategies and policy documents National Health Strategy (2001) National Health Strategy (2001) DoHC move away from operational management – Health Services Executive (2005)DoHC move away from operational management – Health Services Executive (2005)

6 Timing Busy period of policy formulation in healthcareBusy period of policy formulation in healthcare –Long-term perspective Policy implementationPolicy implementation – short-term –Influenced by political cycle –Eg. Priority of health strategy diminished with changing Minister

7 Financial viability National Health Strategy fundingNational Health Strategy funding –Not supported by Dept of Finance De-institutionalisation of mental health patientsDe-institutionalisation of mental health patients –Without additional finances

8 Strategic alliances Smoking BanSmoking Ban –Strategic alliances to counter the anti-ban alcohol industry Development of Nursing ProfessionDevelopment of Nursing Profession –Strategic alliances needed to transfer to university environment Health Services National PartnershipHealth Services National Partnership –Reduction in strike action

9 Public support Unwillingness to engage with the public has led to difficulties implementing hospital reconfigurationUnwillingness to engage with the public has led to difficulties implementing hospital reconfiguration Democratic deficit has had many negative effects on the nature and progress of healthcare reformDemocratic deficit has had many negative effects on the nature and progress of healthcare reform Poor relationships with media have led to focus on “bad news” stories creating ever-widening divide between the public and the healthcare systemPoor relationships with media have led to focus on “bad news” stories creating ever-widening divide between the public and the healthcare system

10 The practice of reforming in a politicized environment –Story of reforming from the inside out - Frank Ahern –Story of reforming from the outside in – Fergus O Ferrall