Barry Andrews (Dún Laoghaire, Fianna Fail)

I will be taking this matter on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children. I thank Deputy Scanlon for raising this issue. I am glad of the opportunity to address the House on this matter and to counter, yet again, the idea that the Health Service Executive, or the Government, is planning to restore the former health boards.

The Minister for Health and Children confirmed to the House last July that there are management changes under way at the HSE. As part of these changes the HSE has informed the Government that it is proposing to put in place a regional administrative structure, within the national structure, to drive operational performance and accountability on the ground. The HSE has not yet finalised its proposals for these changes. There will not be any regional authorities or any other autonomous structures within the HSE. No change will be needed to the Health Act 2004 to give effect to these management changes. There will continue to be one unified health service organisation. The full, formal accountability arrangements set up in that Act do not change. The HSE will continue to pursue the benefits of service integration, for example, between acute and primary care, and implementing consistent national service standards.

The Minister has made it clear on many occasions that she wants to see health and personal care provided to patients on an integrated basis. There must be accountability throughout the system, at all levels, to deliver on national policies and standards. This can only happen if authority and accountability for operational performance is delegated to regional and local level in a meaningful way. That is what the HSE is proposing to do. It is a natural evolution of the health reform process. The 2001 health strategy highlighted the need to strengthen existing delivery structures at local level within a framework of national standards for the whole health system. One of the objectives of the reform programme approved by the Government in 2003 was to provide clear lines of accountability and to simplify the structures.

The Fitzgerald report into the events in Portlaoise identified systemic weaknesses of governance, management and communication within the HSE. It noted that key people in the process were distracted by other important issues they had to attend to during the period. Those assigned to focus on operations within a region must be enabled to do so. When the Minister wrote to the chairman of the HSE, on foot of this report, she asked him to consider whether the governance and management issues which had been identified in relation to the events at Portlaoise had wider application across the HSE. The Minister acknowledged that the board had already been considering these issues and asked for this work to be expedited.

Following further work within the HSE and in ongoing contact with the Department, the HSE is developing a package of proposals to change the organisation. These changes are designed to enable a single national strategic approach with local regional responsibility for service delivery; to ensure clinical leadership and engagement at all levels; to create a leaner organisation with clarity of roles and accountability; and to provide integrated service delivery for the benefit of patients and optimise efficient use of resources. In summary, the changes involve the integration of the two service delivery pillars, NHO and PCCC, under a single national director of operations who will be responsible for all service delivery with a team of regional operations managers; the integration of the HSE's planning capabilities under a new national director of planning and performance, with a team of national care group-programme managers covering areas such as children, older people, disability-mental health, acute hospitals and primary-community care who would be responsible for setting corporate policy-standards in all these areas and driving performance against these standards; the creation of a clinical care and quality directorate which would drive clinical governance, quality and risk, national standards and protocols and provide clinical leadership within the healthcare system; and the creation of a communications directorate responsible for all communications, including parliamentary affairs.

Some of these changes are already under way. The recruitment process for the director of operations, the director of planning and performance and the director of clinical care and quality has begun. The new director of communications has been appointed. The administrative regional structure is not finalised and has not been agreed yet. It will not involve re-establishing local autonomous structures.

The regional level changes proposed by the HSE will be considered by the Government when they are finalised and submitted to the Minister by the board of the executive. The Government will want to be satisfied that the proposed changes will improve operational performance and accountability, and that they will sit comfortably with the configuration of other public services at local level.

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