Róisín Shortall (Dublin North West, Social Democrats)
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653. To ask the Minister for Health further to Parliamentary Question No. 473 of 3 May 2023, the timeline he is working towards for finalisation and publication of the RHA Implantation Plan; and if he will make a statement on the matter. [21749/23]

Róisín Shortall (Dublin North West, Social Democrats)
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654. To ask the Minister for Health the steps that have been taken in his Department and the HSE to ensure that senior leaders have been freed up from some of their ‘business as usual’ responsibilities to devote time to Regional Health Areas implementation; if external experts and resources have been sought to assist with RHA implementation; and if so, to provide details; if he has established an implementation infrastructure as recommended in a letter from the RHA Advisory Group (details supplied); and if he will make a statement on the matter. [21750/23]

Róisín Shortall (Dublin North West, Social Democrats)
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655. To ask the Minister for Health if the Regional Health Areas Implementation Plan will outline the proposed governance and accountability arrangements for RHAs; if consideration is being given to legislative changes required for implementation, including accountability relationships between and among RHAs, HSE Centre and his Department, as recommended in a letter from the RHA Advisory Group (details supplied); and if he will make a statement on the matter. [21751/23]

Róisín Shortall (Dublin North West, Social Democrats)
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656. To ask the Minister for Health to provide an update on each of the ten key next steps in Regional Health Areas implementation, in tabular form (details supplied); and if he will make a statement on the matter. [21752/23]

Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 653 to 656, inclusive, together.

The Government is committed to the implementation of Regional Health Areas (RHAs), as outlined in the Programme for Government.

RHA Implementation Plan

As the Deputy is most likely aware, a Memorandum on next steps, the programme of work, and timelines for RHA implementation was approved by Government in April 2022. This included a commitment to develop an RHA Implementation Plan, a draft of which is currently being updated following feedback from a wide range of stakeholders including key input/feedback from service and clinical leaders. This draft is due to be brought to the HSE Senior Leadership Team, the HSE Board sub-group on People and Culture, the HSE Board, and others for consideration this month. Subject to the outcomes of these engagements, I intend to bring the RHA Implementation Plan to Cabinet as soon as possible in the coming weeks.

Key Next Steps in RHA Implementation

The Deputy will also be aware that I established an independent RHA Advisory Group of patient and staff representatives from across the health and social care sector in September 2021, which is also due to meet this month. The RHA Advisory Group provides guidance, support, and advice on the design of an implementation plan for RHAs to the Department of Health and HSE officials charged with implementing this work programme under Sláintecare. All of the insights gained from the RHA Advisory Group - including the RHA Advisory Group's suggested next steps - have been considered and incorporated in the RHA Implementation Plan to be presented to Government, where appropriate.

The Deputy will understand that the draft RHA Implementation Plan has not yet been approved by Government and is still undergoing changes. It would not, therefore, be appropriate to detail the proposed next steps in tabular form, though I can assure the Deputy that the published plan will include a set of critical actions for implementation which has been informed by consultation with stakeholders. The plan outlines the approach to RHA planning and design in line with the overall design principles and objectives of Sláintecare, and sets out a high-level programme of work for 2023, with a view to RHAs commencing operation in 2024. Further reforms and devolution of authority will take place on a phased basis through 2024 and 2025.

Governance and Accountability Arrangements including Implementation Infrastructure and Resourcing

Within the HSE, the RHA implementation programme has been moved under the CEO’s office. The draft RHA Implementation Plan is being finalised with direct input from the HSE CEO and RHA Implementation Lead.

An initial high level impact assessment has been completed for the realignment of the current Community Healthcare Organisations (CHOs) and Hospital Groups (HGs) to the new RHA geographies. Further engagement is taking place with service delivery leaders on this matter. Initial work to align these structures into regional pods has already been initiated.

Work has also commenced on agreeing the organisational structure for the national HSE Centre and RHAs. This will be informed by high-level design outcomes, international evidence, and further collaboration with stakeholders to agree an integrated service delivery (ISD) model.

Options for the ISD model - to ensure the optimum structures at RHA level in supporting integrated patient-centred care - have been drafted and considered by the HSE Executive Management Team. These options are built upon the 96 Community Healthcare Networks and hospitals as geographically-aligned with RHAs, underpinned by strong national frameworks. An ISD Working Group has been established that includes service leaders, service users, and multidisciplinary teams (MDT)/clinical representatives to consider and agree a preferred ISD model. Senior leaders from both the HSE and the Department of Health have made themselves available to partake in this group, and continue to engage and prioritise RHA implementation in their respective areas as the programme progresses.

Ongoing engagements aligned to the stakeholder engagement plan have continued to inform both the draft RHA Implementation Plan and further design of the RHA programme (covering in excess of 600 people engaged since January 2023). Key stakeholder groups have included patient representative fora, voluntary organisation representative bodies, and individual staff groups as well as national HR in relation of workforce considerations.

In addition to the above deliverables, an RHA HSE Programme Management Team has been established and is fully in place since the end of March 2023 with external support and experts where required. There has been a dedicated unit in the Department of Health working on RHA design, collaboration, and implementation since 2021 and additional staff/resources are in the pipeline.

In line with the Government Decision in April 2022, RHAs will continue to be part of the HSE rather than their own legal entities and as such will not have their own boards. As internal divisions of the HSE, RHAs will report to the HSE Board via the HSE CEO and the HSE Board retains a governance and oversight role as currently set out in legislation. As such, the primary accountability for corporate governance remains with the HSE Board, sub-committees of the Board, and the HSE CEO. The HSE Board remains accountable to the Minister and Department of Health for all regional and national service provision in line with strategic priorities.

Funding of €5m was approved and allocated to RHA implementation in Budget 2023. This includes funding for the appointment of RHA senior leadership teams. Sanction will be sought from the Department of Public Expenditure, NDP Delivery and Reform for the creation of six new RHA Chief Executive Officer posts. It is planned to advertise and recruit for these senior posts in 2023 with the intention to appoint new leadership teams as soon as possible.

RHA Chief Executive Officers (RHA CEOs) will be fully accountable and responsible for all regional health and social care services in each of the six geographic regions. However, RHA CEOs will report directly to the HSE CEO on the operation and management of the RHAs. RHA CEOs will form part of the core HSE EMT, providing regional input into the development of national policies and standards.

More detailed RHA governance arrangements and accountability relationships - at all levels across the system as a whole - will be clarified as part of the ongoing development of the integrated service delivery model and associated governance. A priority action for 2023 includes the review/revision of the HSE code of governance to include RHAs (corporate and clinical), taking into account wider health system including GPs, patients and Section 38 and 39 organisations, for example. Consideration will continue to be given to any potential legislative changes required for implementation as part of the overall implementation programme and as the RHA integrated service delivery model evolves.