HSE break-up 'would fragment services'

BREAKING UP the Health Service Executive (HSE) into smaller district health boards would be unwise and would risk fragmenting services for patients, the deputy chief medical officer in the Department of Health has said.

Speaking to The Irish Timesfollowing a recent fact-finding visit to New Zealand, Dr Philip Crowley noted the country had "taken an opposite direction to Ireland in how it delivers its health services".

Having created a HSE-like structure, New Zealand, which has a similar population to the Republic, recently broke up its health system into 21 district health boards in an attempt to make services more locally responsive.

However, based on discussions with senior clinicians and policy makers during the visit, Dr Crowley said: “I believe that to break up the HSE would be folly as the reasons for creating a unified delivery system are as relevant today as when the HSE was formed.

“The experience in New Zealand demonstrates the downside of having multiple service providers with the difficulty in getting national policy delivered effectively and the danger of considerable variation in service delivery in different areas.”

At present, access to hospital care in New Zealand is free, while patients must pay part of the fee for seeing a GP and part of the cost of drugs prescribed by family doctors, thereby creating a perverse incentive to use hospitals ahead of primary care.

Dr Crowley said the Republic had much to learn from New Zealand’s control of national drug costs. It spends just half the amount per head on prescribed medication as we do. The Pharmac agency has succeeded in transforming a 20-30 per cent annual increase in drug budget to an increase of 4 per cent per annum.

“They have made some tough decisions regarding new medicines, preventing their introduction on the basis that the cost-benefit analysis is unconvincing. They operate with an agreed fixed budget, and this has been crucial in enabling them to assess every proposed new medication against ones presently funded, and ranking products on the basis of their additional benefit to the population,” he said.

The agency carries out health technology assessments on all drugs entering the New Zealand market and operates independently of the country’s department of health.

The deputy chief medical officer also visited New Zealand’s national paediatric hospital in Auckland, which brought together staff from a number of paediatric hospitals to a single location, as is planned for the Republic’s children’s hospital at the Mater site in Dublin. He said health experts there underlined the benefits of having a national paediatric centre on the same site as a major adult and maternity hospital.

Dr Crowley accompanied Minister for Health Mary Harney on her recent St Patrick’s Day visit to New Zealand.