James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the Senator for raising this matter and for the opportunity to clarify the position. Senator Maurice Cummins has also made several representations to me on this issue.

Under the programme for Government 2011-2016, the Government committed to developing a universal, single-tier health service which guarantees access to medical care based on need, not income. On foot of this commitment, the Government will introduce a system of universal health insurance. A key stepping stone to the new system will be to develop independent, not-for-profit hospital trusts, in which all hospitals will function as part of integrated groups. As a first step on that journey, these groups will be formed on an administrative basis. It is envisaged that this will take place from early 2013 onwards, with groups being constituted and becoming operational as soon as is feasible, depending on their readiness and capacity to do so. Groups will be established on the clear understanding that the groupings and their governance arrangements will be reviewed prior to 2015, to ensure an appropriate environment for the introduction of universal health insurance.

The rationale behind the establishment of hospital groups and trusts is to support increased operational autonomy and accountability for hospital services in a way that will drive service reforms and provide the maximum possible benefit to patients. Each group will have a single consolidated management team with responsibility for performance and outcomes. It is intended that non-executive boards, consisting of representative experts, will oversee each hospital group management team and will have responsibility for decisions in relation to services in all hospitals in the group.

In June this year I appointed Professor John Higgins to chair a strategic board on the establishment of hospital groups. Professor Higgins is head of the college of medicine and health at University College Cork. He has a deep interest in organisational reform and change management. He was the director of the reconfiguration of the health system in Cork and Kerry from 2009 to 2011 and he remains chair of the reconfiguration forum there. The strategic board has representatives with both national and international expertise in health service delivery, governance and linkages with academic institutions. On the advice of Professor Higgins, a project team was established to support the strategic board, consisting of Professor Higgins and the team who were previously engaged in the reconfiguration process in the south, as well as members of the special delivery unit and acute hospitals section of my own Department.

The project team is tasked with making recommendations to the strategic board on the composition of hospital groups, governance arrangements, current management frameworks and linkages to academic institutions. In order to be in a position to do this they carried out a comprehensive consultation process with all acute hospitals and other health service agencies. In carrying out this work, use has been made of video conferencing and meetings have been scheduled to coincide with the presence of international representatives in Ireland, in order to minimise costs.

The consultation process included two days of meetings with the hospitals in the south east, on 9 July and again in October. A significant number of submissions, including one from representatives of the south east, have also been received by the team. Work is ongoing on finalising a draft report on the recommendations for submission to the strategic board for consideration when it meets at the end of this month. When the board has signed off on this report it will be submitted to me and I will then bring it to Cabinet.

I assure Senators that in many areas the hospital groups can be described as marriages made in heaven, but in other areas, they are more difficult. I am aware that the issue of a hospital group in the south east is causing great concern to people in Waterford, Wexford, south Tipperary and Kilkenny. The rationale behind these groups is that we do not have the management expertise to cover the 49 hospitals individually but by having hospital groups, we will be able to get the expertise necessary to turn our hospitals around, as has been done in Galway and is being done in Limerick. We can certainly do it with between eight and ten managers and we can grow new management beneath them. The group system will also give local autonomy.

Recommendations will be made and a discussion will be had at Cabinet but the hospital groups will not necessarily be permanent. If it transpires that a group which looked like it would work at the outset does not work, there will be another opportunity to realign hospitals before the actual hospital trusts are formed. I hope that gives reassurance to people who might be concerned about this. We are still listening to and consulting with people and the draft report has not been presented to me yet.