THE GOVERNMENT is to introduce major changes to the way in which the health services are administered.
The move, approved by Cabinet yesterday, represents the first step towards the eventual abolition of the Health Service Executive.
Under the changes, the current structures that see the HSE run by a board and chief executive will be scrapped and replaced by a new system of seven directorates. These will have responsibility for running different aspects of healthcare.
Minister for Health James Reilly said last night the move was “a step along the way” towards the Government’s plan to introduce a system of universal health insurance.
As part of the changes, there will be an “organisational division” between those parts of the health service charged with purchasing health and social services, and those with responsibility for providing those services.
The Department of Health said this would allow for the implementation of a full “money follows the patient” system where providers were paid on the basis of services delivered.
Under the changes to structures at the top of the HSE, there will be seven directorates: hospital care, primary care, mental health, children and family services, social care, public health and corporate/ shared services.
Seven directors will be appointed to run the directorates, one of whom will be appointed as the director general of the organisation. The Minister for Health will determine the precise functions of the directors.
The department said those appointed will be a mixture of people reassigned from existing top-level positions in the HSE and others recruited by means of an internal competition.
Dr Reilly said the possibility remained that there could be outside recruitment. However, he said the new system was only an interim arrangement on the road to universal health insurance. In the interest of speed, it was much easier to use existing personnel and run an internal competition, because a wider procurement competition could take months.
The Minister said each of the new directorates would have their own budget. They would report to the Department of Health and to the Minister.
The proposed new director general would be responsible for the health service “vote” or money allocated by the Oireachtas.
Dr Reilly said, from a patient’s point of view, the changes at the top of the health service “will not impact immediately on them. What will impact is the ability of the system to react to their needs.”
There were no plans to pay off existing senior personnel, he said, and those who did not secure a top post in the new directorates would have important work to do elsewhere in the health service.
Legislation to allow for the changed structures is expected to be put in place by February.
Separately, the chairman of the current interim HSE board, Dr Frank Dolphin, yesterday announced he is to step down. Dr Reilly is to appoint the current Department of Health secretary general Michael Scanlan to replace Dr Dolphin.
The HSE said last night Dr Dolphin had indicated his availability for involvement in health services reform in the future. The Minister said Dr Dolphin had been a key figure in the transformation process involving the HSE.
MAIN POINTS
HSE top-level structures to be replaced by seven directorates
* One of the new directors will act as director general and be responsible for HSE budget
* Minister to bring forward proposals for reorganisation of the HSE at directorate, regional and local level
* Implementation group for universal health insurance to be set up early next year
* New primary care fund to be established