Eamon Scanlon (Sligo-North Leitrim, Fianna Fail)
Link to this: Individually | In context

I thank the Ceann Comhairle for giving me the opportunity to raise this issue. It has just come to my attention that there is a proposal before the Health Service Executive to reform the HSE regions for administrative purposes. Apparently all the regions will be restored to their former status, with the exception of the north west. I request further information on this proposal. Specifically, I want to know why it is proposed that the north west should be the only region not to be re-established.

The Minister for Health and Children, Deputy Mary Harney, said she planned to achieve more effective changes in the organisational structure of the HSE, and I agree fully with her on this. I am a former member of the North-Western Health Board and have first-hand knowledge of the inner workings of the regionalised system. The North-Western Health Board area was, I believe, one of the most effective in the country. Staff there were dedicated, efficient and conscientious, with a genuine concern for those using the services. I agree that there are major benefits to be gained from regionalising the areas for administrative purposes. It will ensure more accountability and speed up many of the processes. Local staff have the benefit of knowledge of the area they work in and this can mean better and more efficient results for the public, which is what we are all trying to achieve across the health system.

Why, then, is the north-west area being denied this change? Why is it proposed that it be the only area not to be reinstated? Why has there been no consultation with Oireachtas Members or, at the very least, information provided to them regarding this plan? In my constituency, Sligo-North Leitrim, there is a state of the art facility in Manorhamilton, just a few miles from Sligo. There is no shortage of skilled workers in the area. A top class management structure has in place in the north west for a long time.

A meeting was held recently between Oireachtas Members from Sligo, Leitrim and east Mayo with consultants and other doctors at Sligo General Hospital in relation to cancer services. We were requested to organise a meeting with the Minister and Professor Keane. I am glad to say that the meeting will take place on Thursday. I hope everybody will go into that meeting with an open mind to try to resolve, once and for all, a difficult situation in the Sligo and north-west region. All we want, ultimately, are the best treatments and outcomes for our people.

Following the meeting with the consultants, who gave Oireachtas Members a very comprehensive briefing, it emerged that there were nearly 7,000 outpatient clinic appoints at Sligo General Hospital in 2008. I implore everybody to go in with a very open mind and, hopefully, we shall have a resolution to what is a very difficult situation.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

I congratulate the Deputy on covering two topics in his debate.

Barry Andrews (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context

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.