In the most radical restructuring of the State's health services in more than 30 years, health boards are to be replaced by four regional executive bodies, writes Dr Muiris Houston, Medical Correspondent
The move will mean greater professional and consumer representation at the expense of local political representatives, The Irish Times has learned.
The changes are included in a major audit of the health service was carried out by Prospectus Management Consultants in co-operation with the Department of Health.
The report will also recommend that a new national hospitals' agency take responsibility for all hospitals in the Republic, including the independent voluntary hospitals.
In addition, it will recommend that the Department of Health be slimmed down, and that it focus exclusively on strategy development and policy making.
A senior Department of Health source has confirmed the plan will mean a significant reduction in the number of health agencies.
Such is the extent of the restructuring proposed by the Prospectus review that new legislation - to replace the 1970 Health Act - will be required. The Prospectus audit of the health system, due to be formally published early next month, was promised in the 2001 National Health Strategy.
Its publication will coincide with the long-awaited report of the Medical Manpower Task Force, which will outline changes needed to bring about a consultant-provided health service rather than a system overseen by hospital consultants.
The Minister for Health, Mr Martin, is understood to be keen that the health service audit will signal fundamental reform of the system. It is understood he sees the process as much more than an exercise in simply replacing health boards with an alternative structure.
Existing representational models will be changed, with a move to a more executive and professional function by the new structures, rather than one which is driven by local political interests.
However, the source said the issue of whether to integrate the National Hospitals' Agency within the new Health Service Executive, or to establish it as a stand-alone body, had yet to be decided. The agency, which was specifically promised in the 2001 Health Strategy, is seen as fundamental to bringing about real change in the delivery of acute hospital services.
The Prospectus report has not yet been presented to the Cabinet sub-committee on health.
However, after recent problems within the North Eastern Health Board and the recurrent crisis in accident and emergency services, department sources said they do not expect any substantial opposition to the proposals at Cabinet level.
The issue of accountability within the health system is currently being examined by the Commission for Health Funding. Its brief is to look closely at the allocation and subsequent utilisation of health service funding.
It is believed the commission has identified the lack of a uniform information technology system as a barrier to progress in identifying value for money. An independent health information and quality authority will be established to coincide with the publication of the Prospectus report, the source confirmed. The National Health Information Strategy has been ready for publication for some weeks, but has been held back to coincide with the audit.
The emphasis on consumer representation in the new regional structures is a recognition of the success of consumer panels pioneered by the North Western Health Board, The Irish Times has been told.
While patient representation will be implemented at all levels of the service, it is understood there will be formal consumer input at regional health service executive level. Professional representation - from nurses, doctors and other healthcare professionals - will be increased.
With lower levels of local political representation, it is hoped regional structures will function as tighter executive bodies.
There are up to 60 independent agencies involved in the supervision and delivery of healthcare at present. It is understood that one of the key recommendations in the Prospectus report is to reduce the number by up to a half, with a view to improving efficiency and accountability.