Ivor Callely (Dublin North Central, Fianna Fail)

I thank Senator White for raising the issue and for the manner in which she raised it, highlighting some important points and aspects in the presentation of her case. I am pleased to have the opportunity to explain the underlying rationale for the decision made by the Government on the health service reform programme last June. The Government decision followed a number of searching reviews of governance and organisational aspects of the health system and aims to put in place a modern management and accountability framework designed to meet the more challenging requirements of the 21st century, to which I think we all sign up. While the health board model introduced in 1970 had many benefits, it also proved to have significant drawbacks. The design of the new structures has taken full account of both aspects of that experience, as well as the latest thinking internationally in organisation, design and up to date governance requirements. The health service reform programme now in the course of implementation is based on the Government's decisions following the Audit of Structures and Functions in the Health System – the Prospectus report – and the report of the commission on financial management and controls in the health service.

Central to the decision is the establishment of a single health service executive for the health services in Ireland. Both reports identified this as the most important change required to establish the organisational improvements needed to meet the challenges of implementing the programme of development and reform set out in the health strategy document, Quality and Fairness: A Health System for You.

Prospectus Strategy Consultants found that in the past, in an attempt to meet the diversity of patient needs and respond to local consumer and political involvement, a number of structures and functions had been duplicated or executed in different ways. While accepting that the intention was often to meet the needs of multiple stakeholders it found that the result was sometimes weak integration of services and multiple contact points for patients.

Since the 1970 Health Act, the scope and level of activities mandated for health boards dramatically increased. In this period, individual health boards evolved at different paces, resulting in a considerable geographic variation in service standards and availability, organisational structures and administrative practices. National strategies and policies added additional functions to individual health boards, for example, in areas like population health and social inclusion. While difference in approach by individual boards could be advocated as promoting innovation, it also resulted in a lack of standardisation across the health system, even in fundamental areas like entitlement or access to particular services. In addition, the different structural approaches taken in response to their expanding functions increased the likelihood of variable performance between health boards. The analysis undertaken suggests that the different pace of evolution and the current structural differences both within and between health boards led to practical difficulties in a number of areas such as, for example, ensuring a standardised approach to the implementation of national strategies and working on a conjoint basis on individual service or policy matters.