Consistency of care the 'clear dividend'

A reform of the health service will provide a greater consistency of care for patients rather than significant economies in the €9 billion cost of running the Department, writes David Labanyi.

The Minister for Health, Mr Martin, said he was not in a position to quantify the possible savings following the structural changes proposed over the next three years. The clear dividend, he said, would be improved consistency of medical treatment for the public countrywide.

At its essence, the reform programme will see day-to-day responsibility for administrating health services shift from health board CEO's and given to the director of the soon-to-be established Health Service Executive (HSE).

The reforms are based on two expert reports; the Brennan Report on value for money in the health service, and the Prospectus Report which audited health structures. Both independently concluded that the Irish health care system has too many small health agencies and a lack of a clear management structure.

As a result the 58 existing health agencies will be reduced by amalgamation and abolition to 27, with four regional offices and 32 local health offices delivering regional and local non-hospital services reporting to the HSE.

Mr Martin said while the HSE would deal with operational matters his Department would be reorganised and assume responsibility for strategic planning.

The National Hospital's Office will take responsibility for all the hospitals in the State. It will oversee the establishment of regional centres of excellence.

This office is to be established on an interim basis immediately and will make potentially contentious decisions such as which local hospitals may have their services downgraded.

The Minister said he hoped to complete the legislative process of changing the 1970 Health Act to facilitate the new changes in 18 months.

The goal of the reforms, he said, were hospitals as regional centres of excellence with consultant-provided care available 24 hours a day, seven days a week. The number of new consultants required to achieve this will be known with the publication in July of the Hanly report on medical manpower.

However, Mr Martin said given the large numbers of new consultants likely to be required it was essential that the consultant contract was renegotiated.

The Minister for Finance, Mr McCreevy said the percentage of annual Government spending allocated to health rose from 19 per cent in 1997 to 24 per cent in 2003. He said an increase in the efficiency and productivity of the health system was required in return for its €9 billion funding in the Department of Health.

Despite the planned reforms, Mr McCreevy refused to give any commitment on funding for the Health Strategy over its 10-year implementation period.

Therefore patients on waiting lists or visiting accident and emergency will find little immediate benefit from the reforms announced today.

They will have to wait until the changes in the consultant's contract leads to increased consultants and changes in the hospital system.

The Taoiseach Mr Ahern said the Health Strategy "set out ambitious targets for developing each element of the system" and today's reforms were to ensure these levels are achieved.

He described the programme as "challenging, but that it threatens no one". The Government confirmed this afternoon that there will be no compulsory redundancies as a result of today's reforms.