Healthcare is so disjointed it’s like having two separate executives on the sidelines, TDs told

The health service is so disjointed it looks like a team on the pitch with two separate managers on the sidelines and the corner defenders playing a different game, the Oireachtas Health Committee was told today.

eo Kearns, chair of the advisory group on setting up six regional authorities in the HSE and bringing back local decision-making, said the way the health service is currently set up in silos cannot work.

Each regional health authority will merge the various silos that oversee hospital and community services, he said. It is about “local ownership, but working within national standards”.

He currently said “however people work, and they work hard and make huge sacrifices,” the lack of a concerted approach between hospitals and community services means it can’t function properly at the moment.

“It’s like paying for a game of football and the manager is on the side of the pitch, but someone else manages the corner defenders who are playing a different game.”

The six regional health authorities that are part of the Sláintecare plan will begin the rollout next year and should be operational by 2024.

He said: “The regional health authorities not only want to enable the integration of community and acute care, but also enable local decision-making and support population-based service planning. This will ultimately strengthen our healthcare system and lead to a better patient experience and access to healthcare closer to home.”

He added that a “key point at the heart of implementation is the belief that the current centralized and hierarchical governance approach to the health service needs to fundamentally and radically change.

“It is not possible to define a clear role for a regional health authority without doing the same for the HSE center and for the Ministry of Health, including how all these entities relate to each other.

“The guiding principle underpinning this work is that of subsidiarity – there must be a guarantee of independence and authority for the RHAs in accordance with the responsibilities they are given; with absolute clarity on how an accountability framework will work; and the same should apply to the HSE center related to the Ministry of Health.”

He said each authority will be a very large and complex entity within the national health service, serving a significant population with a budget of several billions, tens of thousands of employees, and responsible for planning and overseeing integrated services.

They will need to plan and deliver services to multiple national and local service providers – including voluntary and private service providers – and develop integrated service delivery with other sectors, such as local governments.

He said it is essential in this context that the core team for each authority is appointed as soon as possible to take charge of the implementation.

He said it could be a reasonable goal to start hiring for chief executives in early 2023, with a view to appointing the core leadership team by mid-to-late 2023.

However, he warned that given their size, there is a risk that the regional authorities themselves become centralized, top-down organizations, simply introducing a new bureaucratic layer into the health service.

“Therefore, the maximum delegated authority should also be translated into the organizational arrangements within the regional health authorities,” he said.

“This should ensure appropriate levels of authority for decision making at the patient pathway level and enable local and regional structures to enable relationships and trust building across borders. We want to emphasize this point, as the main rationale for RHAs is to enable integrated care pathways for patients and clients.”

Sinn Féin TD David Cullinane said the advisory group’s recommendations differ from those previously signed by the cabinet. He said the cabinet decision would ensure that the regional authorities would be established on an administrative basis rather than a legal basis.

Mr Kearns said the change should not be an exercise in changing loungers. It has consequences for the staff and it is important that there is a plan.

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