The birth of the Eastern Regional Health Authority on Wednesday next marks a new era in the provision of health services to the most densely populated region in the State. With a budget of £1.5 billion, the authority will be expected to revitalise services.
Its predecessor, the Eastern Health Board, was charged with looking after the health needs of 1.3 million people in counties Dublin, Kildare and Wicklow. It will be replaced by three new area health authorities - the Northern, the East Coast and the South Western Area health boards. The Northern board will cover north County Dublin, while the South Western board will look after towns as diverse as Tallaght, in west Dublin, and Athy, Co Kildare. The East Coast Authority stretches from the River Liffey, through south Dublin to south of Arklow, and will service most of Co Wicklow.
Each area board will be supervised by the Eastern Regional Health Authority. It will monitor and evaluate the performance and service delivery within the three areas. Through its planning and commissioning directorate, the ERHA will play a major role in bringing about an integrated cradle-to-grave health service.
The chief executive of the ERHA, Mr Donal O'Shea, is a highly respected public servant with a track record of effective leadership within the health services. It is no coincidence that during his tenure as CEO of the North Western Health Board it developed a reputation for providing the most effective primary healthcare service in the State. He succeeded in integrating GPs, public health nurses and administrators in a team approach to local healthcare provision. It was both innovative and facilitatory and served as a model for other health boards to follow.
In a statement at the launch, Mr O'Shea said: "When people are sick and vulnerable they are least able to negotiate their way around the services and it is my objective in the new structures to ensure that patients and clients will be able to access the service and find their way from one sector to another easily."
The new health authority will both plan and commission health services for each of its three constituent regions. This will bring it into direct contact with the many voluntary hospitals and agencies that are unique to the eastern region. While other health boards have direct operational control over major hospitals in their areas, this has not been the case for the EHB. Hospitals such as the Mater, Beaumont and St Vincent's will, in future, agree service plans with the ERHA. These formal three-year service agreements will cover issues such as the range and quality of services. The first of these rolling contracts will begin next year. In this way, the ERHA will act as a guarantor for the public funds which the voluntary health sector receives, while allowing day to day operational autonomy to continue.
One of the challenges for the authority will be to avoid any unnecessary triplication of services. This will be partly achieved by establishing a shared services centre at the EHB's old headquarters at Dr Steevens Hospital. Information technology, engineering services and facilities management will be provided from here to the ERHA and the three area health boards. It is likely certain medical specialities will be concentrated in a super regional centre located in one area board but will provide patient services to those living in the other areas as well. The ERHA will also have to address the practice where a significant percentage of its services are used by patients from outside its catchment area. This could have implications for the neighbouring South Eastern, Midland and North Eastern health boards.
The link between general practice and hospitals will be high on the ERHA's list of priorities. Most health commentators accept that the gulf between primary and secondary care is significant, with an urgent need for shared care protocols and a linking of information technology between the sectors.
Other immediate challenges are the need to address falling vaccination levels for childhood infectious diseases, a rise in the number of TB cases in the region and the provision of adequate services for the elderly, of which the East Coast Area Board will have the largest percentage. What changes should the health service consumer expect on March 1st? Practically none on the day itself, with care still accessible via the local health centre or hospital outpatient clinic. However, instead of contacting the old Eastern Health Board offices at Dr Steevens Hospital to establish the availability of services, they will be directed to three new area headquarters in Swords, Bray and Naas.
As new structures filter down, the consumer should see an improvement in both the delivery and range of services. By the time the authority announces its first independent budget, the consumer could reasonably expect to see a reduction in waiting times for treatment, a more customer-orientated approach to problem solving and much improved access to preventative healthcare.
Anything less will represent both a missed opportunity and an expensive and ineffective addition to health service bureaucracy.
