“There’s been talk that the HSE needs a Michael O’Leary… it does. …is that something you’d consider in the future and if you were to find yourself in that position how would you go about changing things? …like most people in this room I think the HSE needs a complete and total revolution and thankfully I’m reasonably young so that I don’t make many demands on the health service but I think what’s fundamentally wrong – and I don’t want to get into ‘how would you run the HSE ti-yadda-ti-ya’ – nothing will succeed in this country if it is run by politicians and what is ultimately wrong with the healthcare system in this country is that the government is trying to run it. There is no effective management within the health service because ultimately the unions that are effectively running the show – and running it particularly badly – are by-passing management every time they’re unhappy by running straight to have a meeting with the minister for health and the minister for … I don’t know why we have a minister for health. Governments should create health policy but implementing and delivering health governments should – as they are in most other pieces of infrastructure, transport, health, they are mostly useless and they are utterly useless at it and this flopping around between regional health board HSEs and then the big national HSE and then we go back to the regional HSEs and by-the-way nobody can lose their jobs so every time you create a new administration there’s a whole new load of bureaucrats to sit in on top of the last load of bureaucrats and none of the bureaucrats do anything or can do anything because the unions when they are unhappy will go straight to the government and the government has no power to tell you or the unions to piss off with themselves. I like the American system, Roosevelt it was in the 1930s said if you are a public sector employee the government can’t withdraw your services so you can’t go on strike. You can’t propose that in Europe because it’s almost up there with pedophilia or something like that suggesting that the public sector employees should not be allowed to go on strike but they shouldn’t. They should have arbitration they should have dispute resolution mechanisms but they should not ever ever ever be allowed to withdraw their labour and if they do the government should sack them and you’d solve most of the public sector problems we have in this country. The healthcare service is ultimately not unlike an airline in that it’s a huge big expensive infrastructure provider and the extent to which it is run is that it’s run largely for the benefits of the producers. So you will have people it could be nurses all the way up to surgeons who will work between the hours of 9 and 6 o’clock in the evening and they’re gone weekends. Everyone should be working on 7 day rosters, everyone should be working on shifts, that’s what we do with our pilots and cabin crew. Now the pilots could be working on 5 days on followed by 4 days off but ultimately it’s about production and how do you keep increasing the level of outputs, how do you keep Hospital theatres full 7 days a week, they’re very expensive pieces of kit so like aircraft they should be full operational 7 days a week. They should be running operations 24 hours a day but it needs to be structured that way and it isn’t structured that way but it will never be structured that way as long as it is run by politicians and the unions can influence the politicians and the politicians are unable to manage the unions. And all of that usually brings a tone of joy to a presentation here in the medical community…”

While I was away in San Diego enjoying the brilliant Exponential Medicine Michael O’Leary, CEO of Ryanair, presented the Carmichael Lecture at the Royal College of Surgeons on Ryanair’s new AGB strategy “Ryanair – Always Getting Better” that’s made him a billionaire in the last year. At the end of his talk he answered a great question on the lessons the healthcare industry can draw from the success of Europe’s biggest airline.

mHealth Insight: If you ever find yourself scratching your head in confusion wondering why a healthcare manager is saying something that is completely ridiculous and out of touch with reality re-watch the above 3 min clip of Michael O’Leary’s talk as it succinctly explains the structures that have given rise to the nonsensical models that are bandied about by managers who serve politicians in efforts to generate more benefits for the producers.