All Vision but No Change?: Determinants of Implementation: The Case of Ireland and Mental Health Policy (Issues in Public Administration) by Helen Johnston

Author:Helen Johnston [Johnston, Helen]
Language: eng
Format: azw3
ISBN: 9781910393000
Publisher: Institute of Public Administration
Published: 2015-02-10T05:00:00+00:00

What was not implemented well?

This was the question which provided the most expansive and expressive responses in the interviews. The interviewees gave wide-ranging accounts of things which had not been implemented well in the execution of AVFC. Most of the issues raised have already been mentioned in relation to the views expressed on the actual implementation of AVFC, and many of the points made have been captured in the reports of the IMG analysed earlier in this chapter. This section touches on the main points made, in line with the study’s question on the main determinants of implementation and the three lines of enquiry.

In general, most respondents felt that either the whole AVFC policy or aspects of it had not been implemented well. This perspective included the view that AVFC was developed to ‘placate some groups who were advocating for change in the way our mental health services were delivered... and that the government was not really serious about changing the way we deliver mental health services’.

The main emphasis was on the inadequacy of the top-down elements of implementation, with two-thirds of interviewees specifically mentioning the role of the HSE, as discussed earlier. The lack of accountability was also mentioned. Relatively few interviewees related poor implementation to bottom-up factors but many commented on transformative issues and also on the ubiquitous issue of resources.

The role of the HSE

As in the discussion on the actual implementation of AVFC, two-thirds of the interviewees singled out the role of the HSE as playing a major part in the failure to satisfactorily implement AVFC. Many of the points made in response to this question by the interviewees have already been discussed, so only the main points are reiterated here. These included the HSE’s lack of engagement in the development of the policy:

A Vision for Change was created by a group of people outside of the HSE and handed to the HSE... so the HSE didn’t have an organisational ownership of it, and I think that was a fundamental weakness, the expectation that the HSE would just deliver it.

The lack of priority AVFC was given within the HSE was also mentioned by many interviewees, attributed in part to the lack of engagement by the board or the CEO of the HSE in the delivery of the policy.

A particular aspect which many interviewees highlighted was how the HSE approached the implementation of AVFC, with interviewees describing this in different ways, viz. ‘if the top of the structures had taken more note of what was happening at ground level it might have worked a bit better’, while another interviewee referred to this as the ‘John Wayne approach’.

Many interviewees blamed the bureaucracy and the opaqueness of HSE structures for fudging on the implementation of AVFC, as:

Everything had to come back to Dublin… you can’t implement policy that way… there is meant to be a local power structure with nursing, administrative, medical input… the troika… but it doesn’t seem to have happened.

A number of interviewees commented on the lack of

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