The sole objective of our health policy is to provide every person with access to high quality services. Services have expanded significantly and there are more people receiving care and support services than ever before. I have addressed this House before in relation to the investments and gains made in the health system over the past five to six years. Notwithstanding these gains, I have often referred to the need to couple investment with reform. The purpose of today's debate is to outline the Government's planned reform programme for the health service. The programme will be an essential tool in achieving the improvements in health care which we want and which the public deserve.
It is important to recognise that the reform agenda is a central theme in the health strategy and does not exist outside or separate to our strategic vision for the health system. At the time we published the strategy, we said that structural reform would have to follow. There were complaints that the system was disjointed. Very often patients and clients had to respond to the way services were organised, rather than services being organised to respond to their needs. It was acknowledged that we needed to be certain the structures in place were fit to meet our new goals and objectives. Under action 114 of the national health strategy, I commissioned Prospectus Strategy Consultants to complete an audit of structures and functions in the health system. The central objective of the project was to examine whether the structures in place were the most appropriate and responsive to meet current and future needs in the context of the principles, goals and objectives of the health strategy. Also included in the terms of reference was the need to assess the adequacy of governance, integration and responsiveness to identified consumer need.
The Minister for Finance established a commission on financial management and controls in the health service. The commission, chaired by Professor Niamh Brennan, focused on financial accountability and management issues, but also identified the need for structural reform to support improvements. It is interesting to note that the reports have, independently of each other, reached similar conclusions about the system and have made comparable recommendations. These reports provided the background against which the Government made its decisions in relation to the health service reform programme.
Health board structures are over 30 years old and the wider health system has seen the addition of a large range of specialist agencies during that period, often to give focus to and protect particular policy developments. The result is that there are now 58 agencies operating in the public health system which is, obviously, unsustainable. This multiplicity has resulted in a complex and fragmented system which has itself become an obstacle to achieving improvements. Both reports have emphasised the need to introduce rationalisation, standardisation and a much improved co-ordination to overcome this fragmentation and to give me, as Minister, a realistic span of control over the agencies for which I am responsible. Both reports also reiterated the need to clarify roles between the Department and the delivery system. They also draw attention to the tensions between local representation and decision making vis-à-vis national policy objectives. In a system as complex and as broad in scope as ours, there must be clarity about roles and accountability. The Brennan report focused in depth in this area and made specific recommendations which have also been endorsed in the reform programme.
Issues were raised in relation to the way in which things get done in the system. The need to enhance needs assessment and service planning was recognised. If we are serious about putting people at the centre of care, we must begin with an assessment of needs which informs us about how to plan our services. In turn, once we have declared and agreed service plans, we must link them with funding and measure activity and outcomes. The Government has taken these reports on board and agrees with their analysis of current problems. There have been improvements in all these areas in the past, but these have represented part solutions which are, by their nature, limited. The Government has recognised that it is time to devise a comprehensive and integrated solution.
The principles underlying the reforms are a new national focus on service delivery and executive management of the health services, a reduction in fragmentation within the system, clearer accountability, improved budgetary and service planning and, most importantly, improved patient care. There will be a major rationalisation of existing health service agencies to reduce fragmentation which will entail the amalgamation or abolition of over 30 agencies. This process will include the abolition of the existing health board and health authority structures. A health services executive will be established as the first body ever to be charged with managing the health service as a single national entity. The executive is to be organised on the basis of three core divisions which will include a national hospitals office, a primary, community and continuing care directorate and a national shared services centre. The executive will have its own board and chief executive officer and the board will report directly to the Minister for Health and Children.
The primary, community and continuing care directorate will be made up of four regional health offices of the health services executive at regional level. At local level, existing community care structures will be strengthened to support the maximum local delivery of services and to provide an integrated framework for the development of the primary care model. The Department of Health and Children will be restructured to ensure improved policy development and oversight. There will be a clear separation between the executive and non-executive functions of the Department. Key to its role will be holding the health services executive to account for its performance.
The health information and quality authority as set out in the health strategy will be established as a key independent agency in the new structure. A new governance framework will be developed. The purpose of this governance framework is to ensure that there are common professional parameters across the system designed to deliver accountability, standardisation and value for money. All remaining boards and any new boards established, for example, the board of the health services executive, will be subject to audit against the new governance standard. Supporting processes such as service planning, management reporting, etc. will also be modernised to bring them in line with recognised international best practice.
These reforms are essential to the advancement of the national health strategy. Without them, the health services will not be able to respond adequately to their strategic objectives. The new structures will provide a clear national focus on service delivery and executive management. It will achieve this through reduced fragmentation and the creation of clear and unambiguous accountability throughout the system. In the area of primary, community and continuing care, services will continue to be delivered through community care structures but they will be strengthened and will operate within a fundamentally realigned national management structure. This will be a proper framework within which all primary, community and continuing care services can be integrated.
On acute hospital services, the reforms clear the way for a reorientation of the hospital sector around national priorities, high quality, best outcomes and better value for money underpinning the commitments made in the health strategy. It will provide a unitary approach to the delivery of hospital services and support the even and consistent introduction of consultant delivered services in Ireland. The health information and quality authority will ensure that quality of care is promoted throughout the system by developing a framework of quality standards and promoting the strategic development of information, communications and health technologies within the system. This strengthening of information systems and quality standards will support the evaluation of policy efficacy and system performance.
In the area of accountability, the programme will ensure maximum clarity between roles, clearer lines of accountability and best practice governance. In regard to efficiency and value for money, it also provides for the development of shared services, where economies of scale can lead to resources being freed up for front-line services, improved standardisation and a pooling of expertise and best practice. The delivery of some actions in the strategy will be linked to investment and this will continue to be true. However, the reform programme will ensure that the system can absorb additional investment effectively and will help to demonstrate to the taxpayer and my colleagues in Government that any additional money invested will be well spent in delivering an improved service to patients and clients. The new structures must have a positive impact on the delivery of the Government's health strategy. That is its central premise.
The issue of democratic accountability in the new structure has been raised. As a first step, the most important voice to be heard in planning the delivery of services is that of the patients, clients and their families. Arising from the health strategy, progress has already been made on developing and enhancing the opportunities for such input. Regional co-ordinating committees, consumer panels and advocacy services are all being developed as feedback mechanisms. There has been some misunderstanding of the term "consumer panels".
The objective of consumer panels is to ensure that people who have used services or are current users of services have a genuine influence in the shaping of services locally, in community care areas or at regional level. We have made a good start on that in recent years. It is essential that the people at the coal face in terms of bearing the brunt of particular disease conditions or other issues, have a say in shaping services at local level and that they are involved with the professionals, administrators and decision makers in the health offices of the 32 community care areas and in the new regional health offices. The system will benefit from that type of advocacy. That was the origin of the concept in the health strategy and there are good examples of it happening in the mental health area, in terms of the development of the network and peer advocacy which we launched early last year, in the regional co-ordinating committees in the disability sector and on a number of other specific disease fronts.
With regard to political representation, it was the view of Prospectus, which was endorsed by the Government, that as we have an Exchequer funded health service with centrally determined resourcing decisions, Oireachtas Members should have a responsibility to ensure there is a match between funding of services and national priorities. It is important that public representatives have an opportunity to articulate their views on issues at regional and local level. I intend to place an obligation on the HSE and its regional offices to appraise and inform local representatives and the public generally on service plans and developments regionally and locally. However, it should be noted that the emphasis must be on ensuring that democratic input at regional level is focused on the delivery of national priorities. In addition, the roles of the Oireachtas Joint Committee on Health and Children and the Cabinet subcommittee on the health strategy will be increasingly important in ensuring adequate reflection of the views of public representatives in the ongoing oversight of the health system. I have agreed to bring more detailed proposals to Government on the representation arrangements over the coming months.
I have already mentioned the implications for acute hospital service delivery. I draw Members' attention to this issue because it is another strand of reform which will be put to Government shortly, the report of the task force on medical staffing. The principles emerging are centred on high quality and optimal outcome. International evidence consistently demonstrates that clinical outcomes for patients are improved when they are treated by multi-disciplinary specialist teams operating in units where there are high volumes of activity and access to diagnostic and treatment facilities. However, it is neither practicable nor realistic to suggest that we can provide this within immediate reach of everyone's home. We need to face up to these issues. As a society, we need to achieve consensus about the reality of achieving high quality safe care in a country of this size and population.
I would prefer to achieve Oireachtas consensus on this issue going forward, on a cross-party basis. These issues have dogged successive Governments. For the ultimate benefit of the patient and in the interest of developing the right solution for all concerned, we should—