Major HSE reform aiming for ‘sweet spot’ of meeting standards and community needs

A major reform of the Health Service Executive (HSE) will aim to hit a "sweet spot" of meeting the healthcare needs of local communities while ensuring consistent standards across the country, a senior Department of Health official has said.

The running of health services is to be devolved to six regional health areas (RHAs), which will have responsibility for their respective areas, including budgets.

A detailed plan for how the changes would be introduced will be drawn up by health officials by the end of this year, with the new regional structures to be in place by the start of 2024. A leaner HSE national office will continue to exist to set policy and maintain standards.

Muiris O’Connor, Department of Health assistant secretary general, said there is “incoherence” between the current six hospital groups and nine HSE local community healthcare organisations.

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Shifting to a regional model would allow “population-based funding allocation and devolved responsibility” to better link up various parts of the health service, he told a press briefing on Thursday.

“We want to strike this sweet spot between national consistency and the importance of standards being maintained and consistent levels of high service across the country, with the needs and importance of local responsiveness,” he said.

“This isn’t a change that will be done onto the health system, it is a change that will be done with the health system,” he said.

“For a country of five million people we absolutely don’t propose that highly specialist services would be rolled out one for every region, so there will be national services,” he said.

‘Radical change’

Leo Kearns, chair of a RHA advisory group and Medical Council chief executive, said funding decisions for services would be made closer to the patient on the ground in the new system.

The regional reforms were about “providing better joined up care” to help tackle persistent problems such as emergency department overcrowding and long waiting times, he said.

“No matter how hard people work, no matter how talented people are, or committed they are, the structures we have at the moment simply can’t work, the structures prevent joined up care,” he said.

Mr Kearns said the current system was one where different services were “separated”, which often gave rise to delays, fire-fighting and staff being left “managing crisis”.

There would need to be “radical change” at the core of the HSE and the department for the regional reforms to work, he added.

Dean Sullivan, HSE chief strategy officer, said where care could be provided in the regional areas safely and cost effectively that is what would happen.

Officials also hope the reforms would provide better “coherence” between the State and voluntary providers running services, such as residential centres for people with disabilities.

Mr Sullivan said the changes would help address current “financial difficulties” facing voluntary providers, who have long complained HSE funding does not meet the high costs of providing residential care.

“It’s not sustainable to have a position where services are being delivered at a cost beyond the income provided. That doesn’t mean the answer to that is always increase the income provided, there’s plenty of opportunities to better align those services,” Mr Sullivan said.