The tricky balance between regional and national

Next month the latest structural reform of the health service will commence with the establishment of the six health regions.

The HSE recently announced the appointment of regional executive officers (REOs). Each REO will be the accountable officer in their region. Details of a reorganised ‘HSE centre’, designed to support these regional leaders, are expected to be released shortly. While the Department of Health and the HSE have emphasised the process is only beginning, the aim is for Hospital Groups and Community Healthcare Organisations to be stood down by the end of the year.

On the appointment of the REOs, HSE CEO Mr Bernard Gloster stressed that the structural change, which was recommended in the Sláintecare Report, is not the main goal of this reform.

“The idea behind reorganising our structures is to ensure that people experience just one health service, providing whatever care they need at the right time and in the right place,” Mr Gloster said.

“When we talk about ‘integrated care’, this is what we mean.”

The design of the regions has involved consultation with stakeholders including patients and service users, GPs, voluntary organisations, and non-HSE providers. Finding a balance between regional and national responsibilities will remain a work in progress. The implementation plan, published in July 2023, acknowledged certain specialist services will continue to be planned and delivered nationally. It cites the National Cancer Control Programme (NCCP) as an example. The plan states the NCCP will partner with the health regions in implementing cancer strategies. The exact nature of this partnership is still the subject of discussion. A story in this edition of the Medical Independent reveals how the NCCP National Director Prof Risteárd Ó Laoide wrote to the HSE Chief Clinical Officer Dr Colm Henry in October to request a cancer clinical director be appointed in each region. Prof Ó Laoide also noted that the National Ambulance Service would have direct links with the regions under the proposed structures and the NCCP required similar links to fulfill its mandate.

The same dialogue is taking place across the health service. Another story in this edition is on how the HSE human resources directorate is considering the impact the transition to the regional structure will have on staff. The scale of the process should not be underestimated. It comes just over 10 years since the last major restructuring initiative with the creation of the Hospital Groups. These Groups, it should be remembered, were initially intended to pave the way to Independent Hospital Trusts – a reform that never occurred. It can only be hoped the Department of Health and the HSE have learned from the mistakes of the past. What the health service certainly doesn’t need is the distraction of another redesign in a decade’s time. The health regions are now upon us and it is in everyone’s interests that they succeed.