Report will recommend some radical changes

Radical changes in the culture of the health service, including clear targets for hospital performance and improved rights for patients, are recommended in the Department of Health's strategy document.

The Minister for Health, Mr Martin, is expected to publish the long-awaited report - a late draft of which has been seen by The Irish Times - by the end of the month, the Department of Health said yesterday.

In future, every government policy will have to be "proofed" against standards laid down to ensure it helps to actively improve general health standards in Ireland.

Multi-annual budgeting will be introduced over the lifetime of the strategy to help health boards plan their operations with "reasonable certainty".

However, past spending will not guarantee future State funding. "It is important to reduce our dependency on incremental approaches, influenced significantly by the allocation given in a previous year," says the document, which emphasises local needs must be taken more into account.

Existing accountancy rules, known as the Casemix Budget Model and used to monitor the efficiency of 32 acute hospitals, will be altered to encourage "efficiencies and equity". Specific targets will be given to hospitals to cut waiting lists, while incentives will be offered to increase productivity. Funding to voluntary agencies should be subject to agreed contracts, it proposes.

Management standards should be improved, and senior doctors given a role in deciding on the use of resources. In addition, computerisation should be radically improved, it suggests.

The Taoiseach, Mr Ahern, will head a special Cabinet sub-committee on health, along with Mr Martin, the Minister for the Environment, and the Minister for Social, Community and Family Affairs. Existing funding rules for the health service, using general taxation backed up by private insurance, will remain in place. A change would offer "few tangible advantages". A national health authority will be created to lay down standards of best practice and improve accountability, while a hospital services' advisory authority will advise on the planning, organisation and location of acute hospitals.

Development of acute hospitals has in the past been hampered by the lack of a clear, overall policy, it notes: "We must plan and develop our services on an objective, cross-regional basis," the report adds.

A modernisation unit will be established at health board level to manage reforms: "Change of this level will require careful management and will involve significant development of the system's capacity and capability."

Noting that the country's health board structure has been in place for 30 years, the document proposes a fundamental review of "the number and role of existing agencies".

It adds: "This is the time to take stock of what we want from our health system, and what sort of organisational structure we need to provide it," it says. A review should be completed within six months.

The reform will not be confined solely to the health boards and other agencies: "The Department of Health's own structures have changed relatively little in recent years despite the period of rapid change that we have experienced," it says.

A major effort must be made to improve the skills of health workers and to ensure they stay working within the system, perhaps by using flexible working hours and other family-friendly policies.

The document recommends all health workers, not just doctors and nurses, opticians, dentists and pharmacists, be registered. Existing arrangements currently work by self-regulation.

In future, however, representatives of the public will be offered places on the statutory registration bodies, and the legislation will be reviewed within five years of introduction.