The HSE is beyond repair... but there’s a solution
After quitting his top job in the HSE, Professor Martin Curley says there’s still hope for the future of healthcare
PROFESSOR Martin Curley is on his way back from a short skiing trip in the Dolomite Alps in Italy with his son. They were, he sighs, the ‘best three days of my life.’ As we continue to talk, it becomes clear why the break was so badly needed.
It’s less than a week since Curley quit his job as Director of Digital Transformation and Open Innovation at the HSE and he’s still coming to terms with this significant and life-changing decision. His slightly cryptic posting on his LinkedIn page compared his stint at the Health Service to an attempt at climbing Mount Everest.
And due to ‘bad weather prognosis and supply chain and funding blockages,’ the ‘ascent’ had to be called off. ‘We could still succeed,’ he wrote. ‘But there would be too many casualties, including me.’
Perhaps the most revealing part of his announcement was the sign off, written in capitals — #NIL ILLEGITIMI CARBORUNDUM, which translates from mock Latin as: ‘Don’t let the b ***** ds grind you down.’
Shortly afterwards he gave an interview to RTE’s Drivetime, leaving listeners in no doubt about his reasons for quitting. His honesty was breath-taking.
The HSE, he claimed, is not fit for
‘There was very much a culture of not delivering’
purpose and he pointed to how the Irish health care system is ranked 80th in the world.
‘We are potentially the worstperforming healthcare system in the Northern Hemisphere,’ he said. ‘So countries like Iran, Algeria, Albania, Serbia, Romania, are ranked as having better healthcare systems and we are spending much more than those countries.
‘I’m an innovation professor and it’s normal to see resistance to new innovations being adopted but the level of resistance that I, and actually many within the ecosystem have seen, has been quite extreme.’
He has been seeing clinicians pulling for change but finds the resistance is coming from people within the organisation who do not have clinical backgrounds.
‘Collectively, I don’t think the HSE has the skill to do it, but more importantly it doesn’t have the will,’ he says.
It’s safe to assume Curley knows what he’s talking about. In the private sector, where he says he was earning ‘ten times’ more than he did at the HSE, he is a giant in his field. Previous jobs include senior vice president and group head for global digital practice at Mastercard, vice president at Intel and director and general manager of Intel Labs Europe.
He’s also written eight books on technology management and is cofounder of the Innovation Value Institute at Maynooth University.
But in 2018, when approached about joining the HSE, he ‘made a conscious decision to serve.’
‘I’d never imagined I’d work with the HSE,’ he says. ‘But I put my hat in the ring, I felt it wasn’t a job you could turn down. I knew a little bit about them but what most came to mind was Brian Cowen’s comment that this was Angola.’
His time at the HSE has clearly left its mark, affecting both his health and his psyche. Unwilling to go into specifics, he claims bullying is ‘completely endemic,’ in the organisation. ‘Unquestionably I was bullied,’ he says.
But as the dust has now settled a little in the last few days, he’s anxious to point out the positives as well as explain why his position at the HSE was no longer tenable.
‘The number one thing I wanted to bring to the HSE was hope,’ he says. ‘I also wanted to bring vision, strategy, energy and digital technology.’
After meeting with senior clinicians and managers to discuss taking on the role of Chief Information Officer and CEO of eHealth Ireland, charged with leading the Digital Transformation of the Irish Healthcare system, he decided to make the move from Mastercard.
‘I was convinced I could add a lot of value,’ he says. ‘I had the honour of helping to fix Intel’s broken IT organisation, we went from a relatively poor organisation to a world class one, I thought I could apply the same approach to the HSE.’
After nine months his title was upgraded to Director of Digital Transformation and Open Innovation at the HSE. But it seems right from the start he knew the organisation was in far worse shape than he could ever have imagined.
‘I’m uncomfortable saying this, but after three days I thought I’d died and gone to hell.’
He explains: ‘Firstly the HSE was way under investing in IT, the NHS was spending about 4% of their budget on digital and IT, the HSE was spending about 1%.
‘Then there was the culture within the IT organisation and the skills deficit. One of the hospital managers, someone very senior, said to me; “When you’re dealing with IT it’s always —- the answer is no, what’s your question?” There was very much a culture of not delivering.’
His first job was a forensic analysis of the department, surveying a large number of the ‘Chief Information Officers and business users.’ He says the results were disappointing.
‘When the scores came back, they were certainly in the bottom quartile,’ he says. ‘And the bottom of the bottom quartile.’
‘Look, we do need to remember, this is an organisation under siege and huge pressure,’ he continues. ‘We need to do whatever we can to support it, morale is low and employees are fatigued, we need to help it.’
His solution to help this ‘very broken’ system was to transform the entire organisation using digital technology. ‘I quickly realised that although there were lots of problems with IT, I felt there was a bigger opportunity,’ he says. ‘We could not just transform the IT organisation, but the whole healthcare system.’
Curley explains that he is already involved in collaborations with other health organisations and companies.
‘The Irish Digital Health Leadership (IDHL) is a steering group, a set of about 80 leaders working together to transform healthcare,’ he says. He lists off the names of several senior consultants and business heads who helped run a national digital health conference in Tullamore last year.
‘We demonstrated TenX solutions that if they were adopted, they could transform the healthcare system,’ he says before outlining how prototypes of electronic patients’ records have already been trialled by an epileptic consultant in St James’ Hospital.
‘It was a collaborative effort and he described it as a 100X improvement in clinician interface,’ Curley explains. ‘One of the biggest issues is that clinicians are working with just 17% of the data they need to make these Realtime decisions.’
However, he claims the project was pulled.
‘Morale in the HSE is low and employees are fatigued’
‘I realised how vulnerable the HSE was to a cyber-attack’ ‘We need construct a new healthcare system’
‘We got a very direct instruction,’ he says. ‘The HSE doesn’t do development, we need to stop this project.’
It was, he says, one example of the ‘type of blockage there was.’
There is another digital ‘breakthrough,’ involving pharmacists, that he claims has also been blocked by the HSE.
‘It called the Health Elevator, where you can go to your pharmacy and you can get tests done for bloods, diabetes, lungs and when you leave you get a personal electronic health record on your phone, or something like a Fitbit, and within 24 hours you get a report that highlights if you have any chronic risk conditions.’
He continues: ‘70% of deaths come from chronic and undiagnosed diseases that could be treated if they were found, we also know from the US that 90% of all healthcare costs come from chronic diseases, so if we can detect these early, we keep the patients healthy and out of hospital and the costs are dramatically reduced.’
He says a pilot scheme was set to be rolled out to six pharmacies. But it too was blocked. ‘We can do all of it for the price of not much more than a PCR test,’ he says. ‘And it’s a real opportunity for pharmacies, who all have treatment rooms. And there’s an issue with younger pharmacists being dissatisfied and leaving, but if we could bring this in, to allow them to practise at the top of their licence, this is such a win, win, win solution.
‘In Ireland we spend 97% of our budget on illness and just 3% on wellness, just small shifts would have a dramatic outcome.’
Curley says some top HSE executives were supportive of the strategy to supply everyone in the country with an electronic health record, which he calls ‘game-changing.’ But he believes there was resistance to the idea of patients having access to their medical records.
‘I believe the HSE, and some other health organisations, (are about) information suppression,’ he says. ‘We need everything to be totally open. When you show up to a clinician, they need to be able to see all of the data.’
Excellent healthcare staff, he says, are being prevented from doing their jobs properly.
‘We have devoted staff working with Victorian style tools,’ he explains.
‘If we could give them better information tools, they would do so much better. And because the information is so dispersed, it’s nearly like Russian roulette. People die in our hospitals because the right information isn’t there.’
The money needed to invest in new technologies is not as much as you might think, he says.
‘In the past the HSE has said they needed €800million to develop electronic health care records,’ he explains. ‘And 20 years ago, it did maybe take millions of dollars to develop these solutions, but now we can develop one in 30 days for €50,000. And to deliver an electronic personal record for everyone in the country — instead of talking €800 million, we’re talking just tens of millions — the price of a cup of coffee or two for each of the population. It’s about taking a whole new vision; we just have to decide to do it.’
But according to Curley, the HSE as it is now, is unlikely to make that decision.
‘In general, around the world, medicine has always been very resistant (to change), there is a history of clinical innovators who have been rejected and people have paid high prices,’ he says. ‘But I would also say there has been extreme resistance in the HSE.’
He adds: ‘I think it’s down to power, people who value power much more than patients, progress and purpose. Most of the leading clinicians are with me and the group (IDHL), they want changes and see digital as an opportunity.
‘But from what I’ve seen it’s been non-clinical administrators who are the barriers, some very senior people.
And it happens across the system, I’ve had so many emails in the last few days, one from a senior consultant who has since resigned. They had a really important solution in their field, which was approved and the budget was there, but middle management has been blocking it. ‘So they’ve since resigned.’ With all these frustrating blockages, perhaps it is surprising that he lasted as long as he did?
‘I stayed so long because I felt I could fix it,’ he says. ‘There were a lot of smart people working with me, but it became so personally intolerable, I couldn’t stay any longer.
‘It’s taken its toll physically and mentally, when I was the CIO I realised how vulnerable the HSE was to a cyber-attack, we were wide open, I was losing sleep over it. I tried to take action, but they weren’t addressed. It was just complete inertia.’
It begs the question, are people dying unnecessarily because of this inertia he believes the department is enveloped in?
‘Oh unquestionably,’ he replies. ‘But I’m not walking away, I think there’s a different path we’re going to work outside the system to bring about these changes, that’s my plan and there are many people with me.’
Last night a HSE spokesperson said it completely rejects the claims made by Martin Curley.
In a statement to the Irish Daily Mail it said ‘We don’t comment on individual members of staff. However, there are two sides to every story and the HSE is confident the full story will be told in due course.’
Curley has recently been appointed as a visiting professor at the University of Bath and gives his inaugural lecture at the end of this month. He is currently in talks with Maynooth University, where he co-founded the Innovation Value Institute. And there’s his ongoing work with the IDHL.
‘We have a vision of how the university could be the driver and make these changes much more quickly outside the system,’ he says. ‘We’re in talks with the largest digital health venture capitalists in the world and I think we can do something breathtaking in Ireland.’
As for the HSE, he says it’s beyond repair.
‘What we need to do is to imagine and construct a whole new healthcare system,’ he says. ‘I’m convinced we can have one that’s ten times better in just a couple of years. It has to be done outside the existing one. I think the (current) system can continue on its own, I just wouldn’t put any energy into it, I’d just leave it there and put all the energy into the new system. You will find the good people will accelerate into it.’
Buoyed up after his short ski break, Curley is impressively optimistic.
‘This can be done and just because we’ve failed so badly, it doesn’t mean that we can’t be successful,’ he says. ‘As an innovator I’m used to getting arrows in my back, you’ve just got to move forward. And it’s all about education. So many people feel like me but they won’t speak up. But I do feel we’re at a turning point, so let’s see where we go.’