HSE braces for showdown as reforms will drive staff cuts
Updated Sláintecare report reveals plans to f latten out administrator numbers nationwide
THE stage is set for a showdown between health service chiefs and HSE administration staff who will be redeployed outside the capital or have their roles changed under new reforms.
An updated report on the Sláintecare regionalisation plan has acknowledged the need to reduce the current managerial and ‘bureaucratic’ structures within the HSE.
Under the so-called ‘HSE local model’, six new geographically aligned Regional Health Areas (RHAs) will replace the nine Community Healthcare Organisations (CHO) and the existing six hospital groups, excluding the country’s children’s hospitals.
Under the new model, which will mark a return to the older regional health board structures before the establishment of the HSE, each region will have its own management
Each region will have its own leader
and accountability structure as well as its own population-based budget.
And while the RHAs will not have separate boards or be considered legally separate organisations, each region will have its own leader and the HSE will remain the overall employer.
The HSE centre, which will remain in Dublin, will continue to be charged with developing national programmes and standard-setting.
The report says: ‘The implementation plan will review organisation design to reform the organisational, clinical and corporate governance and accountability lines in line with Regional Health Area implementation.
‘This will consider the complex health and social care system that includes multiple care delivery organisations and seek to reduce existing management layers, creating a flatter structure to support responsive decision-making on the ground. It will also place a greater focus on health outcomes measurement as a mechanism for assessing performance through the HSPA framework in the long term.’
Significantly, the report indicates that the regional model will improve corporate governance by reducing bureaucratic layers within the health service.
It states: ‘Appropriate response to national/local circumstances and identified population needs in service planning. Timely, locallydriven decisions are enabled, reducing bureaucratic layers and time to make decisions. Regional autonomy is provided for appropriately.’
Ed Molloy, a leading management consultant and former member of the Sláintecare Implementation Advisory Council (SIAC), welcomed the outline set out in the report. Mr Molloy said it is vital bold decision-making and staff restructuring takes place to provide the State with a health service that works. But he warned: ‘There will be resistance.’
Mr Molloy told the Irish Mail on Sunday: ‘The rationale for implementation of the six RHAs is good. It’s well thought out – it’s what needs to happen. The real challenge here will be how this change is pushed forward. There will be resistance.
‘What I would like to see is, at the earliest possible stage, the hiring of the regional heads/general managers for each of the regions; they should be provided with office space and a small core team – a head of finance and some clinical consultant support. We need people who get up every morning and their only role is ensuring that this change is brought forward to their region. They do mention delayering in the report of managerial structures and creating flatter structures – this will cause disruption and the shrinking of promotional opportunities.
‘If you’re going to take out layers that will certainly be resisted. Layers refers to grades and promotional opportunities, but the health service certainly needs this, it really needs delayering as an organisation.’
Mr Molloy said those in charge of implementing Sláintecare need to be aware of the likely push back from within the HSE against the restructuring plans. He added:
‘You can never achieve restructuring with an organisation through a democratic process because everybody has a big stake in maintaining the status quo.
‘There are certain minimal specifications that are non-negotiable in order to make the health service fit for purpose because, right now, it isn’t. The purpose being to provide integrated care pathways, quality safe service efficiently and everything is designed for equal access rather than based on the ability to pay ultimately.’
‘Health service really needs delayering’