New HSE structures will only last two years
Newly-announced structures for the HSE will only be in place for around two years, following which the health executive will be abolished and replaced by a new agency, Health Minister James Reilly has said.
Minister Reilly today published legislation providing for the establishment of seven new HSE directorates by the end of the year, including a director general's office and new primary care and mental health directorates, which will have their own ringfenced budgets.
The HSE board is to be abolished this year. In addition, new hospital groups will be put in place by next year.
The proposed legislation also gives the Minister and his department more direct control in the running of the HSE and provides for greater accountability from the different sections of the health service in how they manage and spend their budgets, to ensure that better value for money and optimal patient care is provided.
The Minister's proposals were announced as it emerged that HSE CEO Cathal Magee is to step down. The Minister said the CEO would leave during the transition period while the new directorates were being set up.
Dr Reilly said Mr Magee, who had three years remaining on his contract, had waived his rights to compensation payment. The Minister denied suggestions that Mr Magee had been 'pushed' and paid tribute to the work of the CEO.
The Minister said Mr Magee's decision had been his own and he respected this.
It had previously been suggested that Mr Magee could have applied for the new Director General job. However, once the plans for the new structures were mooted earlier this year, Mr Magee's future role had been in some doubt.
The new directors will be appointed from within the HSE, while the Director General,who could come from outside the organisation, will be appointed by the Minister. Existing HSE directors who do not succeed in getting the new posts will remain in the HSE on their current salaries.
Under the new arrangements the HSE 'vote' will return to the Department of Health and the Department Secretary General will be the accounting officer for the health services.
Dr Reilly said the HSE would cease to exist in 2014 and it would be replaced by an integrated care agency which would put in place purchaser and provider arrangements for healthcare - splitting the service into purchasers and providers of care. Many other functions of the HSE would be subsumed into the Department of Health, he said.
The Minister said the new structure will allow for a reorganisation of services to prepare for the wider introduction of a 'money follows the patient' system and in the longer-term, a scheme based on universal health insurance which would eliminate the current 'two-tier' system would be in place by 2016.
However, as yet the precise details of how the new system will operate after the phasing out of the HSE have yet to emerge.
Dr Reilly said the measures announced today were aimed at changing the health system from one perceived as self-serving to one that was patient-centred.
He stressed the importance of having a ringfenced primary care budget, and said the new funding system would allow for measurable outcomes in primary care, and allow for more patients to be treated away from hospitals at the least level of complexity in a cost-effective way.
The changes announced today will form the basis of the Health Service Executive (Governance) Bill, which is expected to be passed in the next Dail session after the summer recess.
Under the legislation, the Minister can issue directions to the HSE on the implementation of Government policies 'where the Minister believes that the HSE is not having sufficient regard to such objectives or policies in performing its functions.'
The new seven-pillared directorate, will through the Director General, account to the Minister on how the HSE's functions are performed.
The Minister said unless the new system did not help improve the patient's journey and patient outcomes, the changes would be 'valueless.'
Mr Magee today denied suggestions that there were differences between him, Dr Reilly and the Department of Health about the way the health service was run.
He told RTE's News at One that he took his decision to step down from his post as a result of the Government's plans to replace the existing HSE structure.
Mr Magee warned there may be further cuts in hospital bed numbers in the autumn. He said moves to cut spending on agency staff may impact on staffing levels and that this might result in further bed reductions.
Minister of State at the Department of Health Roisin Shortall said today Cathal Magee's departure was a significant blow to the health service "and in this very challenging time of severe budgetary pressures he will be badly missed."
Meanwhile, it has been announced that Minister Reilly is to appoint two further outside consultancies, which will provide special financial expertise for the Department of Health and the HSE. These consultancies will be tendered for.
In addition, two experts from the recently-appointed PA consultancy to the Special Delivery Unit are to advise on stress-testing the impact of cost containment policies and to assess the financial situation in hospitals.
[Posted: Wed 18/07/2012]