The Minister for Health has recommended that the HSE be dismantled over time and replaced with a “much leaner national health agency.”

Simon Harris has been outlining his vision to the Oireachtas Committee on the Future of Healthcare today.

The committee is charged with developing a long-term 10-year strategy for the Irish health service, supported by broad political consensus.

In his opening address to the committee, Minister Harris said that in the longer term the HSE should be dismantled and replaced with a “slimmed down body; one more equipped to lead than to directly control and, accordingly, with less management layers between the top and the front line.”

He warned however that in the meantime the existing legislation needs to be overhauled to improve the HSE governance structure.

“Subject to the Committee’s report, I intend to ask my Department to come forward with proposals to improve governance arrangements for the HSE for so long as the HSE continues in its current form,” he said.

Changing demands on healthcare

He said countries all over the world are facing difficulties providing universal access to healthcare as populations live longer, living standards improve, new treatments are developed and technology advances.

“The demand on our health service will probably always challenge the level of provision,” he said. “At any given point in time, there will always be limited resources available. That is just a reality.”

However he said the 10-year plan will be an opportunity to put in place better systems to set priorities and fairly allocate finite resources.

“Over the next decade we need to get past the stage of constant fire-fighting to a place where we can have a mature debate about how to set priorities and where to develop our services,” he said.

Streamlined national health body

He warned that while many of the HSEs statutory responsibility could be transferred to regional hospital groups and community healthcare organisations (CHO), others will need a “national body for their proper discharge.”

He said national initiatives including the integrated care programmes, Fair Deal and the eHealth strategy have been successful and warned the service cannot return to stand-alone regional organisations like the health boards which were dissolved to make way for the HSE in 2005.

“The overall HSE project initiated in 2005 can be legitimately criticised in a number of areas,” he said. “But the need for national arrangements for planning and sharing of expertise and services for a population of less than 5 million people cannot.”

The minister said the question remains as to whether the new streamlined health body will report directly to the Department of Health or to “an organisation at a remove from government.”

While the ultimate recommendations of the committee will come from its cross-party membership, Minister Harris outlined an eight-point plan that he believes should underpin the future of the health service:

• Shift our model of care towards more comprehensive and accessible primary care.
• Increase health service capacity, in the form of physical infrastructure and staffing, to address unmet need and future demographic requirements.
• Exploit the full potential of integrated care programmes and eHealth to achieve service integration around the needs of patients across primary, community and acute care.
• Strengthen incentives for providers to effectively respond to unmet health care needs by ramping up Activity Based Funding.
• Empower the voice of the clinician and provide them with opportunities to contribute to the management of our health services.
• Further develop Hospital Groups and Community Health Organisations, align them geographically and, as they develop, devolve greater decision-making and accountability.
• Follow this with the provision of a statutory basis for Hospital and Community Health Organisations, operating as integrated delivery systems within defined geographic areas.
• Once statutory responsibilities and accountabilities are devolved from the centre to Hospital and Community Health Organisations, dismantle the HSE and replace it with a much leaner national health agency. In the interim, reform the existing legislation within which the HSE operates to improve governance.

Trade union approval

Responding to Minister Harris’ remarks, the trade union representing health service clerical, administrative and managerial staff said it believes many unions could support the majority of the minister's proposals.

IMPACT said it supports the view that the HSE could be significantly downsized with a small number of integrated regional health groups reporting directly to the Department of Health.

The union’s national secretary, Eamonn Donnelly said his own Oireachtas submission was “very close to what the Minister said at the Committee today.”

“I think we can find much common ground with Minister Harris so long as he also recognises the need for proper resourcing and staffing across the health service,” he said. “And if he listens to the experience and concerns of his reform-fatigued staff, for whom this would be the third fundamental structural change in health service configuration in less than 15 years.”