Vol. 574 No. 5
140 Ms O. Mitchell asked the Minister for Health and Children his plans to reconstitute health boards following the local elections in 2004; and the steps he will take to ensure some level of democratic accountability in the health service. [27400/03]
The health service reform programme is based on the Government's decisions relating to the audit of structures and functions in the health system and the report of the Commission on Financial Management and Controls in the Health Service. Both reports identified this as the most important change required to establish the organisational improvements needed to strengthen the capacity of the health system to meet the challenges of implementing the programme of development and reform set out in the health strategy docu ment Quality and Fairness: A Health System for You.
The Government agreed that health boards and the Eastern Regional Health Authority will be abolished as part of the overall health reform programme. It considered that, as we have an Exchequer-funded health service with centrally determined resourcing decisions, Oireachtas Members should have greater responsibility to ensure that there is an appropriate match between funding of services and national priorities.
Prospectus strategy consultants found that, in an attempt to meet the diversity of patient needs and respond to local consumer and political involvement, several structures and functions have been duplicated or executed in different ways. It was accepted that the intention is often to meet the needs of multiple stakeholders. Nevertheless, the result is sometimes weak integration of services and multiple contact points for patients.
That situation derives from the fact that, since the Health Act 1970, the scope and level of activities mandated for health boards have increased. In that period, individual health boards have evolved at different paces, resulting in considerable variation in their organisational structures and practices. National strategies and policies have also added a number of additional functions to individual health boards, e.g. population health, social inclusion, etc. The different structural approaches, taken in response to their expanding functions, increase the likelihood of variable performance between health boards.
It would be impractical to expect identical structures across the boards, particularly given the variation in geographic and demographic profiles, as well as varying service needs between each board. Nevertheless, the analysis suggests that the different pace of evolution and the current structural differences both in and between health boards leads to practical difficulties in a number of areas, for example, ensuring a standardised approach to the preparation and implementation of national strategies, and working on a conjoint basis on individual service or policy matters.
In addition to moving to a single service executive delivery unit, the Government has also endorsed the need for improvements in governance in many aspects of the system, including the existing health board structures. Some of the concerns raised in the analysis related to: potential tensions between local area concerns, regional interests and national policy objectives; 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.
