Dr. Donal O'Hanlon:

Our structures in the health service need to be better aligned on a local level. The division between the community care organisations and the acute hospital sector, and the acute mental health sector, the fact that they report to different management structures, needs to be reconsidered. It does not make sense to develop a system this way. The term used these days is "geoalignment". We have also been concerned at the lack of a governance structure. We have an executive in the HSE, but very few governance structures nationally, or even in local community health organisations or hospital groups. The integration of that governance function for the acute hospital service, community services and mental health services in a geographical area would be a great advance. That would allow us consider some things that would be beneficial. In any of those groups we need a coherent ehealth system where we can pool information on people, and not duplicate tests or go over the same information again and again at each patient contact. Those systems need to be able to talk to each other between those different community organisations. That also touches on the issue of staff burn out and the mental health of staff. That cannot be minded by a large organisation of more than 100,000 employees. It has to be a part of the management structure locally to try to sustain people in their work.

The NTPF is a short-term solution but it has some drawbacks in continuity of care and we would be much better off funding capacity that would stay with us over the years. The pathways of care could be greatly helped by having a coherent integrated health service management structure on a large regional basis.