Regional healthcare to return in biggest restructuring of HSE in 15 years

The Government will give the go-ahead this week for the biggest restructuring of the Health Service Executive (HSE) since it was established almost 15 years ago.

Minister for Health Simon Harris is to bring proposals to Cabinet on Wednesday to re-establish six regional healthcare structures around the State, which will have high levels of autonomy.

The change will essentially result in a partial return to the old health board system that was in place before the HSE came into being on January 1st, 2005.

The move towards such a fundamental restructuring reflects Government thinking that the HSE is not fit for purpose, as it has become too large and bureaucratic.

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Sources said yesterday there was a need to devolve the services more to the regions, and that would mean setting up a modern iteration of the old health boards. The corollary would be, the sources said, that the HSE would become a much smaller and slimmed-down organisation, with responsibility for governance, oversight and national management of the service.

This change was recommended by the all-party committee that published Sláintecare, the blueprint for the future of the health services. It is also understood to be a priority for the new HSE chief executive Paul Reid.

There were 11 regional health boards throughout the State until the HSE was established in 2005. The organisation, with a staff of 100,000, was conceived to reduce costs and increase efficiency by ending duplication across the country.

However, the centralised organisation proved to be unwieldy, cumbersome and not flexible enough to adapt to local need. It was also politically unpopular.

Since 2011, a process of partial regionalisation has taken place with the creation of nine community healthcare organisations (CHOs). With a geographical spread, they have had responsibility for all non-hospital services including primary care, social care, mental health, health promotion, screening and vaccinations.

However, hospital services have been clustered into six hospital groups around the country. Their regions do not coincide with the borders of the CHOs and in some cases hospitals from one hospital group area are spread across CHOs.

Mr Harris has previously criticised the situation where the CHOs and hospital group regions are not geographically aligned.

The new structures will include all services, hospital and non-hospital, in each region.

Mapped

No details have as yet been disclosed as to how the regional set-up will be mapped. If they are to roughly follow the areas covered by the hospital groups, it would mean separate organisations in Dublin; Leinster; the North-West; Mid-West; South-West and South-East.

The establishment of the HSE represented the biggest restructuring of a public entity since the foundation of the State. Structures, work practices and processes had been so different in the health boards that it created difficulties in delivering services on an integrated basis.

A new system called PPARS, which was designed to integrate personnel, payroll and related systems across the HSE, was abandoned in 2005 after its initial estimated cost of €8 million escalated to some €150 million, including €60 million in spending on external management, technology and consultants.

In 2009, the HSE initiated its first restructuring with the appointment of four regional directors. The Fine Gael-Labour coalition which came to power in 2011 had undertaken to dismantle the HSE and replace it with a new model based around universal health insurance. However, that policy was jettisoned in 2014.