The Health Service Executive (HSE) said today proposals to change the body’s management structure would be phased in over an 18-month period.
Under the new proposals, authority for running hospital and community services will be devolved to new regional management structures.
The current system has been strongly criticised by politicians, unions and patient groups for being too bureaucratic, for taking too much power away from local areas and for frequently passing issues up the line to Dublin for decisions.
The proposed reforms represent the second major change to health structures in less than five years. In 2004, the Government abolished the 11 health boards and replaced them with a centralised Health Service Executive.
Under the new plans, regional directors would run hospital and community services in their area and determine how funding provided by the HSE at national level should be allocated. According to informed sources, there could be four or possibly up to eight new administrative regions.
The HSE today met staff representative bodies to brief them on the developments.
HSE national director of human resources Sean McGrath, who is leading a management team overseeing the changes, said they would be introduced in a "planned and measured way" over the next 18 months and will “refine the way we are currently organised and build on the many achievements of staff”.
“Taking account of feedback from today’s meeting with the staff representatives, as well as input from the senior management team and senior managers, we intend providing staff with more information on these changes early next week," he added.
He said that “key financial challenge facing the HSE of addressing the difference between our annual budget and current spending patterns” were also discussed.
Minister for Health Mary Harney defended criticism of the current HSE structure today saying regional cancer centres would not be established without it.
"You cannot expect somebody who’s responsible for the delivery of the services not to also be responsible for the money that those services cost," Ms Harney said.
"What we had in the old health board system was the health boards were responsible for delivering services and somebody else who had no responsibility for delivering services was accountable for the money. I do not believe that leads to good management and good accountability and it is not in the interest of the taxpayer," Ms Harney told RTÉ's News at One.
"And can I say in relation to the HSE, I’m a strong fan of the unified service. We would not be having the eight designated cancer centres being established at the moment being implemented with great speed by Professor Keane if we still had eleven health boards."
The HSE plan to revert to a more regional-based structure are an acknowledgement that the organisation has failed in its current form, opposition parties said.
Labour’s health spokeswoman Jan O’Sullivan said: “According to the Minister for Health, Mary Harney, who pushed the legislation through the Dáil in 2004, the establishment of the HSE, based on a highly centralised control system, was to be the solution to all our problems.
“The reality has been very different. The HSE has never worked, but unfortunately Minister Harney has never had the courage to acknowledge that her own creation was so deeply flawed.”
Ms O’Sullivan said the latest proposal, however, was “unlikely to address the fundamental flaws in the operation of the HSE”.
“What this smacks of is actually more layers of management rather than less. How would putting in a regional management tier, which in the case of the west would stretch from north Donegal to south Limerick, bring the decision making closer to the patient?”
Fine Gael health spokesman Dr James Reilly TD welcomed what he called a “climb down” by the Government.
“If reports that the HSE plans to revert to a decentralised system are true then it is an admission of abject failure by the Government.
“It is a sure sign that the Government botched the single, biggest reform they have undertaken in health.
“I have long been saying that we need a HSE where decision making on services is devolved to regional and local level to the greatest extent possible. The proposals being considered suggest that the message is sinking in.”
Sinn Féin spokesman on health Caoimhghin Ó Caoláin said the move showed that the highly centralised approach of the Government and HSE management to healthcare delivery is failing.
“Simply regionalising management structures is not enough. Health minister Harney, with the full backing of her Government colleagues, has insulated herself from accountability. She hides behind the HSE but it is her and her colleagues’ flawed policies that pull the strings. These changes provide for no democratic accountability at State or regional level," he said.