Health Regions plan lacks clarity 

The Government’s implementation plan for the establishment of six new Health Regions has provided more questions than answers. 

The need for reform is broadly supported. The current HSE structures divide governance and funding along acute and community sector lines, with separate management and accountability arrangements. It is intended that the six Health Regions (formerly known as regional health areas) will help align community and acute services and enable population-based resource allocation and governance to better provide integrated care. A population-based resource allocation model will be developed “to inform the distribution of available healthcare resources according to population need”.

This represents a major change management programme. The Health Region “approach” will be established from February 2024, but full implementation will be a “multi-year journey”. The management teams of the Community Healthcare Organisations (CHOs) and Hospital Groups “will support and report” to the Health Regions’ Regional Executive Officers (REOs) in early 2024 while the regional senior executive teams are being appointed. It is intended to stand down the Hospital Groups (except Children’s Health Ireland) and CHOs by the end of 2024. The REOs will report to the HSE CEO and become members of the HSE Senior Leadership Team. The other roles in the regional management teams have yet to be specified.

In the short- to medium-term, at least, this reform programme will present significant additional challenges and risks to a pressurised staff and system, and an added layer of bureaucracy. There is insufficient detail in the plan to determine the chances of longer-term gains. 

Notably, the Health Regions will not be legal entities. In 2022, the Government approved the so-called ‘HSE-Local Model’ as recommended in the Department of Health’s business case. Under this model, the six Health Regions will be set up administratively within the HSE structure. 

The implementation plan lacks clarity on the authority that will be devolved. Indeed, descriptions of the future management arrangements are markedly ambiguous. 

The future HSE Centre and Health Region management structures “will support more streamlined decision-making”. However, the specifics of how this will be achieved are still being determined. The HSE CEO is “currently undertaking a review of the HSE Centre as a part of the delegation of many aspects of operational decision-making to the Health Regions”. 

According to the document, the HSE Centre will focus on activities that are “best performed at national level”, rather than operational matters. Health Regions will have “appropriate” operational budget authority, including over their staffing and “other resources” within a framework of “standard policies and national priorities”. 

The plan sets out a timeline of actions during 2023 and 2024. These include defining the structure of the HSE Centre and the Health Regions (September 2023); agreeing an integrated service delivery model for Health Regions (August 2023); and clarifying the Department of Health’s continuing role in the context of the changes (March 2024). 

It is clear from the document that much remains to be defined and agreed. So for now, hope is tethered by considerable trepidation.