Dáil Éireann debate -
Thursday, 6 Mar 2003

Vol. 562 No. 6

Written Answers - Health System Report.

Michael D. Higgins

Question:

74 Mr. M. Higgins asked the Minister for Health and Children if he has received the final draft report of the audit of the structures and functions of the health system undertaken by Prospectus Management Consultants; if the report has now been brought to Government; if it is intended to publish the report; and if he will make a statement on the matter. [6641/03]

Minister for Health and Children (Mr. Martin)

It has to be acknowledged that the present structures in the health system evolved from a model developed over 30 years ago. During that time, the size, range of functions and complexity of managing the system have all grown dramatically. There have been significant enhancements to the original health board model, through the Health Acts 1996 and 1999, as well as considerable changes to the internal structures of the Department of Health and Children and the health boards. A number of new advisory and executive bodies have also been established in recent years. One of the issues which came to the fore during the consultation process on the health strategy was the complex structure of decision-making, roles and responsibilities within the health system, the many layers and intersecting roles, and the lack of consistency in the development of systems and the application of schemes.

One of the main conclusions in the health strategy was that while the system has served us well in many respects, some significant concerns remain. These include the need for stronger co-ordination and integration of functions and services; greater consistency in access to services and delivery of services throughout the country; and greater clarity around levels of decision-making in the full range of organisations, particularlyvis-à-vis the role of the Department, and the requirement for “whole system” effectiveness.

Action 114 of the strategy was intended to support organisation development in helping to clarify roles and co-ordinate the work of different organisations. It was for this reason that Prospectus Strategy Consultants were contracted in June of 2002 to complete an audit of structures and functions of the health system. The terms of reference included consideration of the structures and functions of both health boards/authority and other specialist, advisory, regulatory and executive agencies under my aegis. The terms of reference also require Prospectus to make recommendations to improve corporate governance arrangements in the health system generally. This includes consideration of interactions between all agencies who play a pivotal role in the system, including the Department of Health and Children. The outcomes sought are to ensure that the structures in the system are: the most appropriate and responsive to meet current and future service needs; constitute an adequate framework for overall governance of the health system; achieve an effective integration of services across all parts of the system; adequately represent the views of consumers in the planning and delivery of services; and focus on the principles of equity, accountability, quality and people centredness and the national goals of the strategy.

The project is being overseen by a steering group. Drafts of the report have been provided to the steering group and further work is being completed by the consultants. On completion, I will bring the report to the Government for decision. Once decisions have been made by Government I anticipate that the report will be published in full and made available generally.