Republic of Ireland Health Service Reforms

Mr Denis DohertyChange Management

TeamHealth Service

Executive

BACKGROUND

• National Strategy – “Quality and Fairness – A Health System for You”.

• Primary Care Strategy.• National Cancer Strategy.• Women’s Health Strategy.• Cardiovascular Strategy.• Audit of Structures and Functions in the Health

System (Prospectus Report).• Report of the Commission on Financial Management

and Control Systems in the Health System (Brennan Report).

• Value for Money Audit (Deloitte & Touche).

GOVERNMENT DECISION

• Major rationalisation to reduce fragmentation.

• Health Boards/ERHA to be abolished.

• Dept. of Health & Children to be reorganised.

• HSE to be appointed to manage health services as a single national entity.

• HSE to consist of:– National Hospitals Office– Primary Community & Continuing Care

Directorate– National Shared Services Centre

• Four Regional Health Offices.• Establish a Health Information and Quality

Authority.

HEALTH BILL 2004

• Executive empowered to manage and deliver services or to arrange for other bodies to do so.

• Board of 11 members (Ministerial Appointees) & C.E.O.

• All functions, other than MOH functions, vested in the Board.

• Board may delegate to C.E.O. who may delegate to others who may also delegate to others.

• C.E.O. is the Accounting Officer.

• 3 year Corporate Plan.

• Annual Service Plan.

• Annual Capital Budget.

• HSE to prepare Code of Governance.

• Annual Health Consultative Forum.

• 4 Regional Health Forums authorised to make representations.

• HSE authorised to consult local communities.

• Statutory complaints procedure.

HSE DESIGN APPROACH

Regional Health Offices

Western Region

Southern Region

Dublin and North East

Dublin and Mid Leinster

Regional Health Offices• Regional Offices will

– Facilitate HSE work within the regions. – Service the Regional Fora.– Facilitate consultation with public and service

users.– Ensure service users receive a comprehensive and

integrated response from the delivery system.• Headed by a Regional Director reporting to the

Corporate Affairs Directorate.• Small complement of staff of 25-35.

Local Health Offices

• 32 Local Health Offices (LHO’s) will be established using the existing Community Care Area boundaries which will incorporate all PCCC services and personnel.Hospital Services

• Hospital services will be managed, on an interim basis through 10 hospital networks.

How it Will all Fit Together• Effective integration to be delivered through

– Strong corporate commitment.

– Devolved decision making.

– Clinical and service governance.

– Effective performance management systems.

– Integrated care pathways and care planning.

– Appropriate incentives.

– Corporate, service and business plans which emphasize integration and multidisciplinary working.

Population Health

A population health approach promotes and protects the health of the whole population or subgroups, with particular emphasis on reducing health inequalities.

It takes account of all the determinants of health and recognises that health is the responsibility of all sectors, communities and individuals.

Population Health Functions

• Strategic Planning and Evaluation.

• Health Intelligence.

• Health Inequality and Social Inclusion.

• Health Promotion and Improvement.

• Communicable Disease Surveillance & Control and other Health Protection issues.

Population Health Directorate

• Underpins HSE corporate planning.• Provides single interpretation of national policy

and strategy.• Promotes interventions based on best evidence.• Informs achievement of VFM through evidence

and information.• Provides strengthened health protection resource.• Interfaces with DOHC, HIQA, other agencies and

sectors.

Population Health Structure

• National corporate function led by Director of Population Health.

• Local delivery of function (e.g. Health Promotion) will be through LHO and / or Hospital Network.

Primary, Community and Continuing Care (PCCC)

• Will manage and deliver a range of Primary Care and Specialist Community based services to local populations.

• Will include traditional community care services, continuing care services and those services provided by independent contractors.

• Will provide a vehicle for the implementation of the Primary Care strategy.

Primary, Community and Continuing Care (PCCC)

• PCCC Directorate will provide enhanced capacity in relation to policy interpretation and implementation planning.

• Devolved local decision making.• Regional collaboration to ensure effective delivery of

services which cross LHO boundaries.• Involvement of individual service users, their families

and communities in the planning, design and delivery of services in their area.

PCCC Functions• Population based needs assessment and care

planning.• A single interpretation of Policy, Legislation,

Regulations and Entitlements.• Securing, allocating and monitoring the necessary

resources in line with the National Service Plan. • Individual Care Planning/Case Management. • A realignment from the current model of service

delivery to a population based model.

Hospital Services

• Evolutionary process reflecting Hanly I and awaiting recommendations from Hanly 2.

• Hospital services will be managed, on an interim basis through 10 hospital networks.

Hospital Services (1)

• The HSE will seek to apply parity of treatment in the relationship with all hospitals. This will be underpinned by the following principles:– Fairness in resource allocation and

staffing arrangements.– Alignment of clinical decision making

and accountability.– Standardised key performance indicators.

Hospital Services (2)

– Promote integration of hospital services through networks and contractual arrangements.

– Common compliance with standards of good governance.

– Development of a performance management model that rewards superior corporate performance.

– System wide standards of quality.

National Shared Services

• Deliver economic benefits through consolidation and standardisation of processes.

• Some processes will continue to be carried out locally.

• Transition teams will be put in place. • Full consultation with the staff/representative

associations involved. • The provision of necessary training and support.

National Shared Services Structure

• Shared Services will provide processing for the following functions: – Finance, Human Resources, GMS,

Procurement and ICT. These functions will be delivered on 5 lead sites (one of

which will be multifunctional). These are: – Kilkenny, Manorhamilton, Swords, Finglas (GMS)

and Dr. Steevens.

Human Resources

• HR Management – is a primary function of line management.

• Devolution of responsibility & accountability to line management.

• Supported by a strong corporate HR framework.

• Investment in training, development and performance management systems.

HR Main Functions

• Employee Relations– Industrial Relations, Employee wellbeing & welfare,

Legal/advisory services, Partnership.

• Employee Resourcing– Workforce planning, Recruitment, Employment

monitoring and control.

• Employee Performance and Development– Performance management, Learning & development,

Management development.

• PPARS.

HR Directorate

• Ensure the implementation of APPM through best practice human resource and employee relations strategies/policies.

• Support and further develop Partnership.• Transaction processing element of HR to Shared

Services;– payroll– recruitment – personnel administration– superannuation.

Change Management & Organisational Development

Lead and deliver strategic approach to managing change. • Central Resource:

– develop best practice change management methods and tools.

– ensure standardised approach to implementation.– Develop leadership capacity.

• Local Support: – Deliver internal consultancy to local change

management projects through local response units.

Streamlining of Specialist Agencies

• Implications of the dissolution of current governance arrangements identified.

• Proposals on where agencies’ functions will fit within the high level organisational structure.

• Arrangements for continuity of business.• Contribution to National Service plan.• Financial transition planning process established.• Integration of Agency websites to ensure continuity.

Specialist Agencies to be Part of HSE

• Comhairle na nOspideal and Hospital Bodies Administrative Bureau.

• HSEA• GMS (Payments)

Board.• HeBe• OHM• NDSC

• NHO

• HR

• Shared Services

• CMOD

• CMOD/HR

• Population Health

Finance Functions

• Financial Planning.• Statutory Financial Reporting and Treasury

Management.• Financial Reporting, Control & Policy

Development.• Evaluation, Costing & Contracting.• Leading FISP Development.• Procurement & Value For Money.

Finance Directorate

• Ensuring HSE’s immediate financial management needs are capable of being delivered from January 2005.

• Resources deployed at appropriate levels to support managers & clinicians.

• FISP will ultimately deliver enhanced financial management for HSE nationally.

• FISP will facilitate the delivery of high volume transaction processing via the National Shared Services Directorate.

Information & Communications Technology (ICT)

• Strategic ICT planning and management.

• ICT architecture, policies, standards and methods.

• ICT programme/projects management.

ICT Structure

• Corporate ICT directorate in Naas

– Dealing with strategic elements, overall leadership, policies & standards.

• Operational shared elements through Shared Services.

• Non- shared elements delivered at local level.