Will the new structures be more than a rejig?

The division of the health service into six regions has raised more questions than answers

So the next stage in the health system’s merry-go-round has been announced. The health service is to be divided into six regional areas, based on recommendations in the Sláintecare Report.

Making the announcement, the Minister for Health Simon Harris said the regional division of the health service will “result in clear financial and performance accountability, empower frontline staff and devolve authority from the HSE to the local regions. These proposals will help shape the future of healthcare in this country and will give the staff, and more importantly, communities a greater role in the delivery of health.”

Sounds like an unquestionably good idea. Right, move along now, nothing to see here. Except, that reading between the lines, there’s plenty to see and even more to be concerned about.

Those of us with a long memory will recall the mismatch in service delivery when 11 autonomous health boards ran the show. From a primary care point of view, the progressive place to be was the north western health board. But if you were a GP in the eastern health board, innovative thinking was laughed at.

So while in theory it will be good to have hospital and community services run by a single organisation, ending the current mismatch, where is the guarantee that a patient in west Kerry will be able to access the same quality of service as his cousin in Tallaght?

The HSE, with its central command and control structure, never came close to achieving geographic equity for patients. At present, if you have had a stroke and are being discharged from hospital and in need of occupational therapy, the form-filling and variable services on offer mean you will experience radically different wait times than your friend who lives across the county boundary. What hope is there of equity with six autonomous regions in place of the HSE?

As ever the devil of the new structures is in the detail. A novel bureaucratic term to strike fear into those of us working at the frontline, “collaborative design process”, has been coined. It’s a Yes Ministerish fudge to describe a design process that is expected to take up much of next year, with the new regional structures due to come into operation in 2021.

Tellingly, the Minister said that, under the reforms, patients would still be free to choose where they seek care, while hospitals could maintain their existing academic links even if this cut across new regional boundaries. So if you choose to be looked after outside your new region, how will your discharge home be coordinated? And if you are an academic physician in the Mater Hospital, how can you continue to closely collaborate with your UCD colleagues in St Vincent’s Hospital, which finds itself in a different region from its erstwhile north city equivalent?

If as the Minister claims the HSE is “not fit for purpose”, you would expect some information detailing how he plans to thin out its top-heavy layers of management. But, in yet another omission, we are told there are no plans at present for a redundancy scheme to reduce staffing levels.

One of the few positives to emerge from setting up the HSE in 2004 was the emasculation of local councillors who automatically opposed any rationalisation of the health system. It was important to hear Minister Harris say that membership of the boards overseeing these new regional structures will be based on “competency skillsets”, and not local councillors.

Meanwhile, lurking in the background is a real elephant in the room. With no money there will be no meaningful healthcare reform. An ongoing failure to publish the 2019 multi-billion euro capital plan for health is further evidence that the spiralling national children’s hospital costs have forced other projects to be scrapped. When it comes to the inevitable costs associated with this latest reform, where will the money come from?

If a prime purpose of the 2004 creation of the HSE was to take local politics out of the equation, perhaps the ultimate test of the latest rejigging will be whether bloated layers of ineffectual management have left the building.

What about better and safer patient care you ask? I’m afraid it will be another case of move along now, nothing to see…