Varadkar reveals plans to replace HSE with more local structures

The Health Service Executive is too large and too remote from the health service frontline and should be replaced,

Minister for Health Leo Varadkar told the Cabinet.

In a draft memorandum for Government last month he said the HSE had been successful in some of its national functions but "the centralised command and control model is not conducive to good management of hospitals or community services".

“It will be replaced by new structures that will devolve more decision-making to the level of the hospital or community and ensure greater accountability.”

The Minister said an immediate priority was to develop a capacity for commissioning services “with the aim of driving a value-based purchasing agenda on behalf of patients”.

He suggested systems would be put in place to allow for more care – some day cases and minor injury services – to be carried out “beyond the hospital walls” in primary care facilities.

Mr Varadkar's draft memorandum to the Cabinet on future health service reform has now been published by the Department of Public Expenditure and Reform on its website. In the memorandum, Mr Varadkar said the key challenge for the Government was to find a way to deliver universal healthcare at a cost that was affordable and sustainable for society.

“This cannot be achieved without refocusing our health service away from a hospital- centric model of care and towards a more preventive model that is grounded in more comprehensive primary care.

“Simply put, primary care is essential to delivering a modern, responsive and cost effective healthcare system and promoting population health,” the draft memorandum said.

The Minister said he wanted to strengthen and enhance primary care by developing programmes for the management of chronic disease; negotiating a revised GP contract, continuing the roll-out of GP care without fees; and expanding multidisciplinary primary-care teams and associated infrastructure.