I thank Senator White for raising the issue and for the manner in which she raised it, highlighting some important points and aspects in the presentation of her case. I am pleased to have the opportunity to explain the underlying rationale for the decision made by the Government on the health service reform programme last June. The Government decision followed a number of searching reviews of governance and organisational aspects of the health system and aims to put in place a modern management and accountability framework designed to meet the more challenging requirements of the 21st century, to which I think we all sign up. While the health board model introduced in 1970 had many benefits, it also proved to have significant drawbacks. The design of the new structures has taken full account of both aspects of that experience, as well as the latest thinking internationally in organisation, design and up to date governance requirements. The health service reform programme now in the course of implementation is based on the Government's decisions following the Audit of Structures and Functions in the Health System – the Prospectus report – and the report of the commission on financial management and controls in the health service.
Central to the decision is the establishment of a single health service executive for the health services in Ireland. Both reports identified this as the most important change required to establish the organisational improvements needed to meet the challenges of implementing the programme of development and reform set out in the health strategy document, Quality and Fairness: A Health System for You.
Prospectus Strategy Consultants found that in the past, in an attempt to meet the diversity of patient needs and respond to local consumer and political involvement, a number of structures and functions had been duplicated or executed in different ways. While accepting that the intention was often to meet the needs of multiple stakeholders it found that the result was sometimes weak integration of services and multiple contact points for patients.
Since the 1970 Health Act, the scope and level of activities mandated for health boards dramatically increased. In this period, individual health boards evolved at different paces, resulting in a considerable geographic variation in service standards and availability, organisational structures and administrative practices. National strategies and policies added additional functions to individual health boards, for example, in areas like population health and social inclusion. While difference in approach by individual boards could be advocated as promoting innovation, it also resulted in a lack of standardisation across the health system, even in fundamental areas like entitlement or access to particular services. In addition, the different structural approaches taken in response to their expanding functions increased the likelihood of variable performance between health boards. The analysis undertaken suggests that the different pace of evolution and the current structural differences both within and between health boards led to practical difficulties in a number of areas such as, for example, ensuring a standardised approach to the implementation of national strategies and working on a conjoint basis on individual service or policy matters.
In addition to moving to a single health service executive, the Government has also endorsed the need for improvements in governance in many aspects of the system. Recommendations in this regard were designed to support the adoption of a whole health system approach to decision making at both national and local levels. The critique of current arrangements in this context highlighted a number of concerns, including the potential for tensions between local area concerns, regional interests and national policy objectives and the absence of effective mechanisms for resolving such tensions taking a whole health system perspective; competition between representatives on boards based on locality or professional background rather than objective need; decision making which is not always based on best practice or evidence; and a tendency to focus on operational and short-term issues over strategic issues.
The emergence of a single health service executive at national level will entail the appointment of a single board, which will have responsibility for the entire range of health services nationally which are Exchequer-funded. The new structures recommended to the Government obviate the need for and do not incorporate the continuation of local statutory boards. In this context, the Government has agreed that health boards and the Eastern Regional Health Authority will be abolished as part of the overall health reform programme. One of the considerations around the balance that needs to be struck between central and local levels of decision making in this context is the influence which Members of the Oireachtas should have, given their representative role, in determining priorities in a centrally funded health system. I hope my reply so far adequately responds to the question on the organisational aspects of the radical reform package.
I support Senator White's view on a meaningful role for the democratically elected local public representatives. As she and other Members are aware, I have been most involved in the structures of the health boards and health authority. I fully acknowledge the vital, important and meaningful role of the democratically elected public representative. With the Minister, Deputy Martin, I am happy to work with the Association of Health Boards in Ireland which represents all the elected members on this issue. I understand the Minister has already arranged a meeting which will take place shortly with the chairman of the association, Mr. Jack Bourke and the secretary Mr. Matt O'Connor. I keep in contact with the association and have advised it that my door is open at all times to work out the detail of its input. I would be happy to hear from Senator White if she requires any further assistance or information. If she thinks there is anybody else I should meet, I will endeavour to do so.
I am advised that provision will be made for the input of political and other interests in the determination of priorities and plans at regional level. While the detail of this remains to be worked out, a specific feature of the new structures will involve regular contact between senior management at regional level and the relevant public representatives. I support the continuation of this meaningful role based on my experience as a member of the health board-authority and the Association of Health Boards in Ireland.
At national level, Members of the Oireachtas will continue to be involved in the overall governance of the health system through their participation in various committees, for example, the Joint Committee on Health and Children and the Committee of Public Accounts. The new structures will be designed to ensure that an appropriate balance is struck between national priorities and local requirements but in a context which best serves the needs of the whole health system and the population overall. The Government has also accepted that there is a need to strengthen existing arrangements for consumer panels and regional co-ordinating-advisory committees in representing the voice of service users. These structures incorporate patients, clients and other users, or their advocates. They work to provide a bottom-up approach to understanding the needs of service users at a regional planning level. These existing models are at different stages of development and will continue to be enhanced. I am conscious of the concerns about the adequate governance of the new structures in a radically restructured health system.
The Minister has agreed to bring more detailed proposals to Government on the arrangements for political involvement. He is currently completing his consultations with existing health board members, and will reflect on the various viewpoints expressed before tabling more detailed proposals on this in the coming months. I will be happy to listen to the views of Members and ensure the Minister will take those into account before reaching final conclusions for submission to Government. I understand he is satisfied that the new arrangements we are now implementing, combined with the introduction of system-wide best practice governance and accountability systems, will ensure a stronger, more effective health system and an improved health service for patients and clients. I trust that has been helpful.
