HSE top tier may remain in revamp

The HSE is expected to retain most of its its existing senior management tier for the foreseeable future in spite of major changes in the structure of the organisation announced by Health Minister James Reilly last week.

The Minister announced what was described as a major HSE restructuring, with the establishment under new legislation later this year, of six new directorates in the HSE, plus a new post of HSE Director General, which replaces the current Chief Executive post.

The new directorates cover primary care, hospitals, social care, mental health, health and well-being and child and family services.

As part of the changes, the current HSE board will be abolished and the seven directorates, which will be set up by the end of the year, in addition to directing services, will replace the current functions of the board.

However, it was presumed by many, when the announcement was made last week, that the new directorates would be replacing the existing 10 national directorates in the HSE, each currently headed up by highly-paid national directors.

These directorates, in addition to covering client services, also cover areas like HR, audit, communications, corporate planning and finance.

However, it has now emerged that most of this this existing top-level management structure of directorates is unlikely to be scrapped and will largely co-exist with the new management tier until the HSE is abolished around 2014.

It is understood that this was indicated last week to senior HSE managers by Department of Health officials.

HSE sources have stressed that while the new directorates cover specific areas of patient and social care and are intended to replace the functions of the HSE board, the health executive still required structures to run areas such as HR, finances and audit.

A spokesman for the Minister told irishhealth.com that heads of five of the six areas covered under the new directorates will be appointed through competition in the near future and it was envisaged that these plus the existing head of children's services will formally become new directors under a newly-appointed director general when the legislation is passed.

The spokesman indicated that the existing tier of directors would largely remain in place. However, he stressed that the planned restructuring would be an evolving and fluid process subject to further change.

For example, it was intended that the current Clinical Programmes and National Cancer Control Programme directorates would move into the Department of Health before 2014. The new Director General and the Minister would also be able to relocate or redesignate other functions as deemed necessary, the spokesman said.

The new structures are intended to give the Minister and his department more direct control in the running of the HSE and provide 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.

However, the fact that much of the existing senior management tier is likely to remain in place at the HSE and that the new directorate structures will only be in place for two years will inevitably lead to questions about how radical the Minister's reforms are.

However, the Minister has said that after 2014, the HSE will cease to exist and it will be replaced by an integrated care agency which will put in place purchaser and provider arrangements for healthcare.

Dr Reilly's reforms are intended as a lead-in to the introduction of universal health insurance (UHI) in 2016.

Outgoing HSE CEO Cathal Magee has announced that he will be standing down during the transition period before the introduction of the new directorates.

Time for a plain English directorate

[Posted: Fri 27/07/2012]