Forget accountability, just duck, dive, dodge
ON a recent trip to A&E, sardine-like overcrowding meant I could not help overhearing a patient-doctor consultation. The patient, an elderly woman with a serious kidney complaint, required heavyduty medication and her doctor was keen to admit her to hospital for monitoring. The sick woman seemed delighted and gathered her belongings in readiness for her exit. Alas, four hours later she was still in situ.
When a busy nurse stopped for a breather in her vicinity, the woman, presumably worried that she had been forgotten, asked for an update.
‘We have to get two more doctors to see you before you are moved anywhere,’ came the nurse’s reply, while the old woman sank back crestfallen into her armchair.
Some days later, I asked a friend who works in the same hospital why doctors who regularly deal with life-and-death situations do not have the power to sanction a simple hospital admission.
‘There are no beds in the hospital,’ shrieked my friend. ‘The staff are probably afraid to admit a patient in case there’s hell to pay.’
Collective decision-making removes authority from individuals, like the A&E doctor in this instance, but it’s also a method of staff self-preservation.
If something goes badly wrong, then no single individual is responsible; if it goes better than expected, then the perpetually cloaked-in-anonymity ‘team’ can take a bow.
IT’S a bit like the psychology of the firing squad, designed so that the guilt or suspicion of having delivered the killer bullet is shared by all. Spreading responsibility as thin as a communion wafer runs right through sections of the public service. The Garda whistleblower controversy, with its shady tentacles in Tusla, and the various HSE crises – most recently the desperately sad case of Grace, the profoundly disabled girl abandoned in an abusive foster home for the duration of her adolescence and early adulthood – tell us that much.
Two separate reports attempting to get to the bottom of the scandal of Grace’s care reveal a variety of case conferences and social care meetings where no minutes were taken, files went unread, no contact was made with her supposed carers and decisions were made to mollify the foster family, rather than serve Grace’s welfare.
The HSE staff who actually looked out for Grace were the frontline workers at her day centre. They reported the scars and bruising on her body, her sexualised behaviour, her rotting teeth.
THEY cried out for help for silent Grace but the foster-care team and then the adult mental handicap services dragged their feet for nearly two decades as Grace’s file became heavier with reports, recommendations and pointless opinions about making her a ward of court. Time and again, she was recommended for residential care but her foster parents always went berserk at losing their cash cow.
Ultimately, no one was responsible for Grace and it seems like no one will be held accountable for allowing what was intended as a short-term placement in 1989 to continue, despite alarms bells, for two decades.
We can blame bureaucratic inertia, or the managers’ fear that their decision would come back to haunt them, particularly when the then health minister Michael Noonan got involved.
Or we can just blame a management culture and structure where the highest goal is not to display competence or excellence, but to display self-preservation, defined as ducking, diving and dodging.
Between 30 and 40 staff dealt with Grace’s case over the years, five of whom are still with the HSE, six are with Tusla and the remainder are retired or working elsewhere. But no one was in charge.