It was with this in mind that under action 114 of the health strategy, I commissioned Prospectus strategy consultants to complete an audit of structures and functions in the health system. In tandem with this, as Senators know, the Minister for Finance commissioned the Brennan commission to deal with financial controls and management systems. The central objective in the terms of reference was to ensure the structures in place were the most appropriate and responsive to meet current and future needs. Other objectives included in the terms of reference were to assess adequacy of governance, integration and responsiveness to identified consumer need. These issues were to be considered against the backdrop of the four principles and goals of the strategy as they related to equity, accountability, quality and people-centredness. At the same time, the Minister for Finance had commissioned an examination of financial management and control systems in the health service. The commission, chaired by Professor Niamh Brennan, focused on financial accountability and management issues but also identified the need for structural reform to support improvements.

It is interesting to note that the reports have, independently of each other, reached similar conclusions about the system and made comparable recommendations. These two reports provided the background against which the Government made its decisions on the health service reform programme. As I have mentioned, our structures have evolved over 30 years. The basic structure was designed in different times to meet different demands. Successive Governments have set up specialist agencies, often to give focus to and protect certain policy developments. There are now 58 agencies operating in the public health system. This is simply not sustainable. This multiplicity has resulted in a complex and fragmented system which has become an obstacle to achieving improvements. Both reports emphasised the need to introduce rationalisation, standardisation and much improved co-ordination to overcome this fragmentation and give me, as the Minister, a realistic span of control over the agencies for which I am responsible.

Both reports also reiterated the need to clarify roles between the Department and the delivery system. They also drew attention to the tensions between local representation and decision making vis-à-vis national policy objectives. It is obvious that in a system as complex and broad in scope as the health service, clarity about roles and accountability must be completely clear. The Brennan report focused on this area and made specific recommendations which have also been endorsed in the reform programme.

Other issues raised related to the way things get done in the system. The need to enhance needs assessment and service planning was raised. If we are serious about putting people at the centre of care, we must begin with an assessment of needs which informs us about how to plan our services. In turn, once we have declared and agreed service plans we must link such plans with funding and measure activity and outcomes. Both reports had a focus on outcomes and the necessity of being vigilant and focused on health outcomes as well as value for money outcomes.

The Government has taken these reports on board and agrees with their analysis of current problems. There have been improvements in all these areas in the past but these have been part solutions that have only brought us some way forward. Part solutions, by their nature, are limited. The Government has recognised that it is high time to devise a comprehensive and integrated solution for the entire system.

The principles underlying the reforms are a new national focus on service delivery and executive management of the health service, a reduction in fragmentation within the system, clearer accountability, improved budgetary and service planning and, most importantly, improved patient care. To reduce fragmentation, there will be a major rationalisation of existing health service agencies, with over 30 agencies to be amalgamated or abolished. This includes the abolition of the existing health board or authority structures. A health services executive will be established. This will be the first ever body charged with managing the health service as a single national entity.

The executive is to be organised on the basis of three core divisions: the national hospitals office, the primary, community and continuing care directorate and the national shared services centre. It will have its own board and chief executive officer and the board will report directly to the Minister for Health and Children. The primary, community and continuing care directorate will be made up of four regional health offices of the health service executive, with existing community care structures at local level, to deliver regional and local services.

The Department of Health and Children will be restructured to ensure improved policy development and oversight. There will be a clear separation between the executive and non-executive functions of the Department. Key to its role will be holding the health service executive to account for its performance.

The establishment of a health information and quality authority, to which there is a commitment in the health strategy, will also proceed with the new structure. Its focus will be to ensure that quality of care is promoted throughout the system by developing a framework of quality standards and to promote the strategic development of information, communications and health technologies within the system. This structure will be independent of the health service executive and the Department, the reason being that quality assurance must be independent. To have the provider guaranteeing the quality, is not the ideal way forward. We have already established the hospital accreditation agency, which is bringing a new focus on performance within hospitals. That agency will be subsumed, along with other agencies in this field, into the health information and quality authority.

A new governance framework will be developed. All remaining boards and any new boards established – for example, the board of the health service executive – will be subject to audit against a new governance standard to be devised as part of the process. The purpose of this governance framework is to ensure that there will be common professional parameters across the system designed to deliver accountability, standardisation and value for money. Supporting processes, such as service planning, management reporting etc., will also be modernised to bring them in line with recognised international best practice.

These reforms are essential to the advancement of the health strategy as a whole. Without them, the health services would not be able to respond adequately to its strategic objectives. The new structure set out in this reform programme will provide a clear national focus on service delivery and executive management. It will achieve this through reduced fragmentation and the creation of clear and unambiguous accountability throughout the system. For example, Prospectus saw this structure as optimal in terms of allowing the primary care model the opportunity to develop and grow. I refer here to the primary care model developed under the health strategy. Prospectus also saw the advantage to be gained in distinguishing between acute and primary, community and continuing care and stated that that this structure provides the opportunity to "reflect the declared priorities of strengthening primary care and reforming the acute hospital sector . allow recognition of the different management demands of each sector in terms of scale, technology, organisation type and delivery mechanism."

In addition, in the area of primary, community and continuing care, the reform programme provides for a strengthening of existing community care structures. I have already indicated on a number of occasions that services will continue to be delivered through these local health office networks. However, they will now operate within a fundamentally realigned national management structure providing a proper framework within which all primary, community and continuing care services can be integrated.

With regard to acute hospital services, the strategy clears the way for a reorientation of the hospital sector around national priorities, high quality, best outcomes and better value for money. The structures emerging will support the commitments made in the health strategy in respect of the reform of acute hospital services. It will provide a more unitary approach to the delivery of hospital services, which, in turn, will support – this is very important – an even and consistent introduction of consultant-delivered services in Ireland.

In regard to the information deficit, the health information and equality authority will provide the independent authority to support the development of information systems which are inextricably linked to the quality agenda in health. This strengthening of information systems will also provide a greater evidence base for proper monitoring and evaluation of system performance.

Regarding accountability, it deals with the repeated criticisms in relation to accountability within the system, with greater clarity between roles, clearer lines of accountability and best practice governance. In terms of efficiency and value for money, it provides for the development of shared services, where economies of scale should lead to resources being freed for front-line services, improved standardisation and a pooling of expertise and best practice.

The delivery of some actions in the strategy will be linked to investment and this will continue to be the case. However, improving value for investment made and structuring the health system, so that it can more easily achieve its goals, is a vital step. It will ensure that the system can absorb additional investment effectively and will help to demonstrate to the taxpayer and my colleagues in Government that any additional money invested will be well spent in delivering an improved service to patients and clients. The new structures must have a positive impact on the delivery of the Government's health strategy and that is its central premise.

I mentioned the likely impact of the reform programme on acute hospital service delivery. I want to draw Members' attention to this issue because it is another strand of reform which will be put to Government shortly. I refer here to the report of the task force on medical staffing. The principles which are emerging are centred on high quality and optimal outcome. International evidence continually demonstrates that clinical outcomes for patients are improved when they are treated by multidisciplinary specialist teams operating in units where there are high volumes of activity and access to diagnostic and treatment facilities. It is neither practicable or realistic to suggest that we can provide this within immediate reach of everyone's home.

We need to face up to these issues. As a society, we need to achieve consensus about the reality of achieving high quality, safe care in a country of this size and population.

I wish to refer to one further issue before dealing with communications. In terms of democratic accountability, there will be three tiers to the new structure. We have already outlined our commitment to establishing consumer panels at the community health care office level. There has, perhaps, been some misunderstanding about what we mean by consumer panels. The idea of consumer panels is to bring face-to-face with decision-makers, officials and administrators in the health service those people who are either users of the service or families of the users of the service. This could involve patients suffering from a specific disease, such as diabetes, or those with an interest in physical or sensory disability or mental health. We would create panels involving the administrators and others at community care level, to help to shape and deliver services for the future.

There have been some welcome developments on this front in recent years, not least in the mental health area where we have developed peer advocacy networks. There are now advocates in every area of the country who previously used the service and who are best placed to have some say in how services are developed in the future.

At the regional office level of the primary community and continuing care tier, we envisage public representatives having the opportunity to articulate their views on the health service to the regional health officers or executives of the regional health office. There will be an obligation on the regional health office to apprise public representatives at regional level of the plans for the forthcoming year and to update them on progress made on health care objectives, etc. This is stated in the decision of the Government and the consultation phase in which we have just engaged – it will go on for three months – will, hopefully, flesh out some of those details.

At national level, we see an enhanced role for the Oireachtas Committee on Health and Children in terms of oversight of the Minister and the health services executive. The committee already has a significant role in that regard and the Committee of Public Accounts has an ongoing role in financial and accountability matters. There is a Cabinet sub-committee, which was formed after the publication of the national health strategy, which is working on the ongoing implementation of this reform programme.

We accept that managing the change programme will be challenging. We do not understate the enormity of the task ahead. Change is going to depend on the people working in the system. In that context, the reports do not criticise the people in the system but rather the system itself. They emphasise that our human resource is a key strength. Health, after all, is about people looking after people. The reports suggest that existing structures are actually hampering and stymieing the full implementation of that human resource potential.

The first step in implementing the new structures will be an extensive programme of communication and dialogue with key stakeholders. I have already started on that process. A number of key groups were briefed on the day before the publication of the reform programme. We called in all the health service managers and the various agencies and informed them of the decisions we were about to take. We also met the chairpersons of the health boards before the formal launch of the programme. Since then, a nationwide series of seminars, which are specifically targeted at taking the message directly to the staff in the system, have been arranged. I have already visited three health board areas. I will visit a fourth – the North Eastern Health Board area – and where we intend to meet the staff. Following the meeting I had with the chairpersons of the boards, we will also be meeting the members of those boards – including elected representatives. We have also met the national partnership forum in health and representatives of the trade unions involved in the sector. These meetings form the initial consultation phase of the programme of reform. As part of the initial consultation phase of the reform programme, we have met with the national health partnership forum as well as with trade unions involved in the health sector.

The Government decision provides for the commencement of a communication and consultation process, which I want to see completed by end October. The purpose of the consultation is to engage with people working within the system to elicit views on the best pathways to implementation and to flesh out the structural framework in detail. The office for health management has been commissioned to co-ordinate, manage and report on the process. The preparations for the consultation phase of the communications process are well advanced and the first sessions will commence within the system on 9 July.

As an immediate priority, I will set about establishing robust structures to drive the implementation as soon as possible. This will include a national steering committee and a project office to oversee and progress implementation. The project office will comprise a significant number of people whose sole function will be to drive this reform programme forward. One of their first tasks will be to prepare a detailed project plan setting out a timetable for various elements of the reform programme, including identification of those actions that can be tackled early.

The Government has also agreed to the establishment of an interim board of the health service executive as well as an interim national hospitals office. I intend putting these structures in place in the autumn in order to take early action on advancing the reorganisation of the hospital sector on the basis of the type of principles that, it is understood, will emerge from the Hanly report, which is to be published shortly. In addition, I hope to make an early start on the internal restructuring of the Department itself.

I am determined to move forward as quickly as possible with this implementation. The decisions made will reinforce and build on the efforts to date in creating a more innovative and participative working culture in the health services, focused on continuous improvement in service quality. This programme is about formulating a framework for developing services and maximising the impact of these services on the patients who rely on them.