Regional health areas could just add bureaucracy, Medical Council chief warns

Politicians have been warned of the risk that new regional health areas (RHAs) being brought in under the Sláintecare plan for reforming healthcare could “simply introduce another bureaucratic layer to the health service”.

An overhaul of Health Service Executive (HSE) structures is set to bring in six new RHAs.

This is happening on the back of recommendations in the cross-party Sláintecare report that regional bodies should be responsible for the planning and delivery of integrated health and social care services. Responsibility for implementing the plan lies with the HSE and Department of Health.

Leo Kearns, chief executive of the Medical Council, who was appointed chairman of an advisory group on the RHAs, was questioned by TDs and senators on the plan at the Oireachtas health committee on Wednesday.

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“A key issue at the heart of the RHA implementation is the belief that the current centralised and hierarchical governance approach to the health service needs to fundamentally and radically change,” Mr Kearns said.

He added that in determining levels of authority “the bias should be towards providing maximum devolved authority”.

He said each RHA would be “a very large and complex entity within the national health service” that serves a significant population with a budget of multiple billions of euro and tens of thousands of staff.

The committee was told it was essential that the core leadership teams for each RHA were appointed as soon as possible and a reasonable aim was to start recruiting regional chief executives in early 2023.

Mr Kearns cautioned: “Given their scale there is a risk that RHAs could themselves become centralised, top-down organisations and simply introduce another bureaucratic layer to the health service.”

The committee heard there must be “appropriate levels of authority for decision-making at the level of the patient pathway”.

Sinn Féin TD David Cullinane said there were fears that under the current plans “everything stays the same at the top and then we just reconfigure underneath. Nothing changes.”

He asked Mr Kearns if he agreed there needed to be a shift in attitude.

Mr Kearns said the advisory group’s advice was set out in his opening statement and if it wasn’t the outcome “then, as we say in the statement, this is fatally undermined”.

He said that advice was being given to the HSE and the department, which he believes are committed to the RHA project.

“It may be that there’s a growing understanding of all of these issues, but it simply will not work if we’re just moving the chairs on the deck,” he added.