Key questions unanswered as new plan to decentralise HSE unveiled

KEY decisions about the future of surplus health staff, including highly paid managers, in the new-look HSE were dodged yesterday, despite claims that it will be slimmed down and streamlined.

Health Minister Simon Harris confirmed the HSE would be divided into six regional health areas.

These will have more power over local decision-making, with their own budgets, while answering to the executive on major issues.

He said the proposed overhaul would cut duplication of departments and functions in community services and in hospitals, while there would be fewer managers.

However, he would not be drawn on what would happen to managers with reduced responsibility who would still be on the same generous salary, and whether a redundancy scheme would be introduced for excess staff in the reorganisation.

HSE director general Paul Reid said he was not planning a redundancy scheme.

The reluctance to acknowledge some of the more unpalatable aspects of the shake-up opens up the spectre of a repeat of 2005, when the HSE

was set up to replace health boards, with no overhaul of staff, reducing the chances of workforce efficiencies.

The minister said the changes would 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 healthcare,” he said.

The boundaries were decided following analysis of patient service usage patterns across the country.

The six new regions should be “self-contained” to allow for a population-based planning and funding model.

The new divisions are: Area A – north Dublin, Meath, Louth, Cavan and Monaghan.

Area B – Longford, Westmeath, Offaly, Laois, Kildare and parts of Dublin and Wicklow.

Area C – Tipperary South, Waterford, Kilkenny, Carlow, Wexford, Wicklow and part of South Dublin.

Area D – Kerry and Cork. Area E – Limerick, Tipperary North and Clare.

Area F – Donegal, Sligo, Leitrim, Roscommon, Mayo and Galway.

While the regions will have devolved responsibility for decision-making, they will operate under a national framework, including national policies covering areas such as cancer, screening programmes and ambulance services.

The “leaner” HSE will hold on to responsibility for national services including finance, but the full extent of the control of the regional bodies has yet to be clarified.

There were no answers yesterday to questions about what would happen, for instance, if there was an instruction at national level to axe a hospital service, but this was opposed by local managers.

The promise is that the new structure will also increase accountability, but so far, the plan lacks detail on how this will be achieved.

The new structure will not be in place until 2021 and in the meantime, stakeholders in each of the regional health areas will be asked to give their views on what the design should look like.

It will be driven by the Sláintecare office, which is headed by Laura Magahy.

Mr Reid said he believed the new system would support staff to deliver the best possible care.

This echoes the same promises which have been made with all the previous remodelling which has been carried out in the HSE and later unravelled.

Former HSE chief Tony O’Brien said a devolution of responsibility within the healthcare system was long overdue.

“These changes are politically attractive. They’re relatively easy to announce and slightly harder to implement, but they do also come with a cost,” he told RTÉ radio.

He said uncertainty could affect productivity among staff and that major reform should be followed through on, rather than started and abandoned.