Role of clinical department leads a ‘key’ focus of HSE review

The need to “empower” clinical department leads at hospital level is a key focus of the HSE’s review into the clinical director role, the head of the review working group has said.

Prof Pat Nash, Regional Clinical Director for HSE West and North West, was speaking at the HSE Integrated Healthcare Conference in Dublin on 3 September. The review of the clinical director role was commissioned by HSE Chief Clinical Officer Dr Colm Henry last year.

Speaking to the Medical Independent following his address, Prof Nash said he hoped the review would help hospitals and regions, “look at the role going forward and see how we can adapt it… to be the best fit for the new [regional] structures and Sláintecare.”

Prof Nash would not be drawn on specific recommendations in the report, emphasising it “is still a draft report” and engagement with stakeholders is ongoing.

However, he said one of the important issues is ensuring doctors can access training at an earlier career stage, “so it’s a role that they can feel equipped to take on.” A key aspect is ensuring “educational support and mentoring of people coming into these roles”.

During his address, Prof Nash said the multidisciplinary review group had examined current clinical director roles in Ireland and international best practice. It has held multiple meetings with a wide range of stakeholders.

According to Prof Nash, there are just under 200 doctors with a clinical director title in the public health service out of a consultant population of about 4,500. He also revealed results from a survey of current clinical directors, which has been conducted as part of the review.

According to the survey, 50 per cent of respondents said the current model had “average effectiveness”. Only 17 per cent reported they had “access to timely and relevant performance data”. Some 12 per cent felt they had the ability to influence the allocation of resources, while 83 per cent said they had influence over quality and safety.

Prof Nash said clinical directors often feel they have “all the responsibility without the authority”. The substantial variation in role titles, remit, and organisational structures has also been raised during stakeholder engagement. In addition, stakeholders have highlighted inconsistent contractual, working time and remuneration arrangements, and a poorly defined relationship between department, directorate, hospital, and regional leadership roles.

Prof Nash added that the “clinical department lead or clinical specialty lead” was one of the areas that is a “key” focus of the report. He told attendees: “We need to empower clinical department leads, appoint them through proper structures and empower them.” The final review report will contain a proposed clinical governance structure for how clinical department leads will report up through the hospital and to regional level.

Full coverage of the HSE Integrated Healthcare Conference in the next issue.