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

The Higgins report on the establishment of hospital groups, which I launched on 14 May, is the most radical and fundamental modernisation of our health system infrastructure since the State's foundation. To achieve the most effective high quality outcomes for patients in the most cost-efficient manner possible, reform of the structures and governance for the delivery of hospital services is now vital.

The report was informed by consultation with management and senior clinicians from hospitals, patient advocates, health agencies, and the clinical programmes, among others. Detailed data analysis also informed the report recommendations. It is important to make special note of the clinical programmes which have been instrumental in improving our health services, in conjunction with front-line staff and supported by the special delivery unit. The stroke programme and the congested heart failure programme were mentioned in the keynote address in Oregon last year by Don Berwick, who was Barack Obama's health spokesperson. Since the stroke programme came into being, we have moved from the bottom of the list in Europe for thrombolysis, the administration of clot-dissolving drugs, to the top and we now save an extra life a week and pre-empt the need for three people a week to go into long-term care.

We know the traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. The formation of Irish acute hospitals into a small number of groups, each with its own governance and management, will provide an optimum configuration for hospital services to deliver high quality and safe patient care in a cost-effective manner. By cost effectiveness I do not mean saving money for the sake of money but saving money to have resources to treat more patients more quickly.

The organisational structures and system of governance in the Irish hospital sector are unsatisfactory. Many Senators will say this is an understatement, because the governance of many of our hospitals in the past has not been at the level it should be. The investigations by the Health Information and Quality Authority, HIQA, into Tallaght hospital and the occurrences there exposed a huge weakness in governance which has helped us learn how better to govern our hospitals. We now have very clear direction on how this should be done.

The existing organisational structures have restricted the development of the management systems and leadership we require to run a world class national hospital network. In reforming the organisational structures for hospital services, I want to take the best elements of governance and autonomy found in our system to create a new governance framework which can yield the benefits of increased independence and greater control of local clinician and managerial leaders to every hospital in Ireland.

We look to ourselves to solve our problems but we also look outside our country. We are a small island nation and we can and do learn from others. In this respect, I thank Sir Keith Pearson for the work he did on governance while the chair of Tallaght hospital. I must also mention Professor Higgins and the huge amount of consultation he did on this issue. A total of 75 formal meetings and more than 70 informal meetings were held.

Since the Government approved the groups' establishment in May, there have been more than 50 additional meetings. I have visited each hospital group to address staff, including clinicians and community staff. We had good interactions. As I told them and as I am happy to confirm on the floor of the Seanad, this is the beginning of a conversation that will continue. People can feed into an e-mail address as they encounter problems on the ground and conceive solutions. The people who deal with our problems on a daily basis are the best placed to deal with them.

The success of the special delivery unit, SDU, was that it visited the front line and the clinical programmes, listened to what people had to say, assessed their suggestions and told them whether their suggestions would work, could work if they were less expensively priced or would not work.

In reforming the organisational structures for hospital services, I want to take the best elements of governance from around the world. As well as benefits in terms of safe, high-quality patient care and cost effectiveness, other key benefits that will arise as a result of the establishment of groups include stronger governance and management structures at the hospital level; an end to hospitals providing the same services unnecessarily within the same geographical area, that is to say, duplication; a concentration of complex services at appropriate hospitals in order to ensure quality; and efficiencies through the avoidance of duplication in terms of HR, finance, etc.

As I have often stated, the idea of model 2 hospital work such as hernia repairs, gall bladder surgery and so on being done in model 4 hospitals is grossly inefficient and is not cost effective. It is like bringing one's ten year old Volkswagen to the Ferrari testing centre. The centre will surely do a great job, but the same job could be done more conveniently and with a great deal less cost at one's local garage.

I am mindful of people's nervousness about the status of their smaller hospitals. Even though the small hospital framework document has been ready for some time, its publication was delayed to coincide with the major hospital groups. The two are inextricably interlinked. The framework demonstrates clearly that the future of smaller hospitals is secure. The establishment of the groups will see small and large hospitals working together as one. This is a key step on the way to the introduction of universal health insurance. There will be a live-in period, as it were, and trust formation lasting 18 months. The groups will be reviewed by the Department of Health to ensure that they are delivering better outcomes for patients as intended. For the CEO of each group, the other key performance indicator will be the amount of resources and worth that have been returned to the smaller hospitals.

When the groups are established, services can be exchanged between sites in line with overarching policy and the group's strategic plans. This will result in the maintenance of activity in smaller hospitals, allowing them to focus on provision of safe and appropriate care. A significant increase in the volume of activity in smaller hospitals is the expected result of these service improvements. One need only consider Louth County Hospital or Roscommon hospital to see the greater range of safe services that they offer to their local populations. At the same time, more complex operations and procedures are kept in those hospitals that are better positioned to deliver them.

The implementation of the recommendations of the group's report has commenced. In the past two weeks, I have visited all of the areas alongside the director general designate of the HSE and officials from my Department. We explained the policy objectives and listened to the staff's questions. This process has been useful and informative and the reaction has been overwhelmingly positive. Since the Government approved the groups' establishment, Professor John Higgins has also been carrying out briefings.

The implementation will be overseen by a national strategic advisory group, which will shortly be appointed, and be driven by the HSE. This group will provide guidance and ongoing direction in respect of the implementation of the hospital groups report and the smaller hospitals framework. It will also provide a forum to resolve issues and assist in the development of specific implementation guidelines on the steps required for full implementation.

I will appoint chairs to each group in the coming weeks. Advertisements to seek other board members will be placed in parallel with this process and the subsequent appointment of group CEOs and management teams. Each appointment will be made based on the competencies an individual brings to the board in line with the Health Information and Quality Authority, HIQA, report on Tallaght, but that will not prevent appropriate representation of the geographical areas in the group. The need to ensure primary and community care is also covered by board membership.

Within one year of the formation of hospital groups, each group will be required to submit a strategic plan that will outline its plans for future services within the group. These strategic plans will determine the way services are provided within each group. Critically, each group will develop its own plan. It must also decide on a new name. We have divided them geographically for indicative purposes. Having visited the Limerick mid-west area, I am aware that its group has determined its new name, that being, "University Limerick Hospitals". Its chair and board are in place and have met three times. The group is well advanced.

It is good that there will be seven groups, including the national paediatric hospital group. That they will operate differently in various fields will provide each an opportunity to learn from the others. Furthermore, instead of having 49 managers and management structures, we will only have seven, six of those in adult services. I intend to ensure that there will be regular meetings between these seven CEOs so that they might exchange ideas of mutual interest.

One of my main criticisms of the HSE previously related to the fact that, despite being a monolithic body that was supposed to deliver uniformity across our services, it did not. Excellence in one hospital was not transposed to other hospitals. A good way of handling scrubs in one hospital was not followed in other hospitals. One hospital's approach to staff was not taken elsewhere. Why are there nine nurses per health care assistant in some model 4 hospitals but only 2.8 per health care assistant in others?

The implementation of these plans by each group will be rigorously reviewed, including all necessary due diligence checks, to determine whether the groups are in a position to advance to hospital trust status after the necessary legislation is put in place, which is planned for 2015. As Mr. Tony O'Brien, the HSE's director general designate, has stated, trust status is not guaranteed. It must be earned and groups must reach the bar.

The Higgins report represents a major milestone in the health reform programme. I am confident that the new groups will help to deliver a more effective and efficient hospital service for patients with better outcomes. If all we do is predicated on better outcomes for patients, we will not stray too far from the right path. Although we have developed some measurements of hospital outcomes, we need more. Measurement is also light in primary and community care. I have invited those involved in these areas to join the Department and the HSE in developing outcome measurements so that we can focus more on those activities that we know improve outcomes for patients and less on those that do not.

By way of a rhetorical question, why is it that, when we have some of the best doctors, nurses and managers in the world, we do not have one of the best health services? The reason is that the health service was allowed to evolve in a chaotic fashion. We are trying to put order on it in a way that allows those who work therein to deliver of the excellence that they have been trained to deliver, are capable of delivering and want to deliver. It is frequently reported to me that people are frustrated by their inability to do their jobs because of the system in which they must work. We want to remove this frustration. For this reason, our meetings have been important and the e-mail address will be important. The reform is ongoing and will be informed by those who work in and use the service.