Transcript Document

Republic of Ireland Health Service
Reforms
Mr Denis Doherty
Change Management Team
Health Service Executive
BACKGROUND
• National Strategy – “Quality and Fairness – A Health
System for You”.
• Primary Care Strategy.
• National Cancer Strategy.
• Women’s Health Strategy.
• Cardiovascular Strategy.
• Audit of Structures and Functions in the Health
System (Prospectus Report).
• Report of the Commission on Financial Management
and Control Systems in the Health System (Brennan
Report).
• Value for Money Audit (Deloitte & Touche).
GOVERNMENT
DECISION
• Major rationalisation to reduce fragmentation.
• Health Boards/ERHA to be abolished.
• Dept. of Health & Children to be reorganised.
• HSE to be appointed to manage health services
as a single national entity.
• HSE to consist of:
– National Hospitals Office
– Primary Community & Continuing Care
Directorate
– National Shared Services Centre
• Four Regional Health Offices.
• Establish a Health Information and Quality
Authority.
HEALTH BILL 2004
• Executive empowered to manage and deliver
services or to arrange for other bodies to do so.
• Board of 11 members (Ministerial Appointees)
& C.E.O.
• All functions, other than MOH functions,
vested in the Board.
• Board may delegate to C.E.O. who may
delegate to others who may also delegate to
others.
• C.E.O. is the Accounting Officer.
• 3 year Corporate Plan.
• Annual Service Plan.
• Annual Capital Budget.
• HSE to prepare Code of Governance.
• Annual Health Consultative Forum.
• 4 Regional Health Forums authorised to make
representations.
• HSE authorised to consult local communities.
• Statutory complaints procedure.
HSE DESIGN
APPROACH
Regional Health Offices
Western Region
Dublin and
North East
Dublin and
Mid Leinster
Southern Region
Regional Health Offices
• Regional Offices will
– Facilitate HSE work within the regions.
– Service the Regional Fora.
– Facilitate consultation with public and service
users.
– Ensure service users receive a comprehensive and
integrated response from the delivery system.
• Headed by a Regional Director reporting to the
Corporate Affairs Directorate.
• Small complement of staff of 25-35.
Local Health Offices
• 32 Local Health Offices (LHO’s) will be
established using the existing Community
Care Area boundaries which will
incorporate all PCCC services and
personnel. Hospital Services
• Hospital services will be managed, on an
interim basis through 10 hospital networks.
How it Will all Fit Together
• Effective integration to be delivered through
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Strong corporate commitment.
Devolved decision making.
Clinical and service governance.
Effective performance management systems.
Integrated care pathways and care planning.
Appropriate incentives.
Corporate, service and business plans which emphasize
integration and multidisciplinary working.
Population Health
A population health approach promotes and
protects the health of the whole population or
subgroups, with particular emphasis on
reducing health inequalities.
It takes account of all the determinants of
health and recognises that health is the
responsibility of all sectors, communities and
individuals.
Population Health Functions
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Strategic Planning and Evaluation.
Health Intelligence.
Health Inequality and Social Inclusion.
Health Promotion and Improvement.
Communicable Disease Surveillance &
Control and other Health Protection issues.
Population Health Directorate
• Underpins HSE corporate planning.
• Provides single interpretation of national policy
and strategy.
• Promotes interventions based on best evidence.
• Informs achievement of VFM through evidence
and information.
• Provides strengthened health protection resource.
• Interfaces with DOHC, HIQA, other agencies and
sectors.
Population Health Structure
• National corporate function led by Director
of Population Health.
• Local delivery of function (e.g. Health
Promotion) will be through LHO and / or
Hospital Network.
Primary, Community and
Continuing Care (PCCC)
• Will manage and deliver a range of Primary
Care and Specialist Community based services
to local populations.
• Will include traditional community care
services, continuing care services and those
services provided by independent contractors.
• Will provide a vehicle for the implementation
of the Primary Care strategy.
Primary, Community and
Continuing Care (PCCC)
• PCCC Directorate will provide enhanced capacity in
relation to policy interpretation and implementation
planning.
• Devolved local decision making.
• Regional collaboration to ensure effective delivery of
services which cross LHO boundaries.
• Involvement of individual service users, their families
and communities in the planning, design and delivery
of services in their area.
PCCC Functions
• Population based needs assessment and care planning.
• A single interpretation of Policy, Legislation,
Regulations and Entitlements.
• Securing, allocating and monitoring the necessary
resources in line with the National Service Plan.
• Individual Care Planning/Case Management.
• A realignment from the current model of service
delivery to a population based model.
Hospital Services
• Evolutionary process reflecting Hanly I and
awaiting recommendations from Hanly 2.
• Hospital services will be managed, on an
interim basis through 10 hospital networks.
Hospital Services (1)
• The HSE will seek to apply parity of
treatment in the relationship with all
hospitals. This will be underpinned by the
following principles:
– Fairness in resource allocation and
staffing arrangements.
– Alignment of clinical decision making
and accountability.
– Standardised key performance indicators.
Hospital Services (2)
– Promote integration of hospital services
through networks and contractual
arrangements.
– Common compliance with standards of good
governance.
– Development of a performance management
model that rewards superior corporate
performance.
– System wide standards of quality.
National Shared Services
• Deliver economic benefits through consolidation
and standardisation of processes.
• Some processes will continue to be carried out
locally.
• Transition teams will be put in place.
• Full consultation with the staff/representative
associations involved.
• The provision of necessary training and support.
National Shared Services
Structure
• Shared Services will provide processing for the
following functions:
– Finance, Human Resources, GMS,
Procurement and ICT.
These functions will be delivered on 5 lead sites (one of
which will be multifunctional). These are:
– Kilkenny, Manorhamilton, Swords, Finglas (GMS)
and Dr. Steevens.
Human Resources
• HR Management – is a primary function of
line management.
• Devolution of responsibility &
accountability to line management.
• Supported by a strong corporate HR
framework.
• Investment in training, development and
performance management systems.
HR Main Functions
• Employee Relations
– Industrial Relations, Employee wellbeing & welfare,
Legal/advisory services, Partnership.
• Employee Resourcing
– Workforce planning, Recruitment, Employment
monitoring and control.
• Employee Performance and Development
– Performance management, Learning & development,
Management development.
• PPARS.
HR Directorate
• Ensure the implementation of APPM through best
practice human resource and employee relations
strategies/policies.
• Support and further develop Partnership.
• Transaction processing element of HR to Shared
Services;
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payroll
recruitment
personnel administration
superannuation.
Change Management &
Organisational Development
Lead and deliver strategic approach to managing change.
• Central Resource:
– develop best practice change management methods and
tools.
– ensure standardised approach to implementation.
– Develop leadership capacity.
• Local Support:
– Deliver internal consultancy to local change
management projects through local response units.
Streamlining of Specialist
Agencies
• Implications of the dissolution of current governance
arrangements identified.
• Proposals on where agencies’ functions will fit within
the high level organisational structure.
• Arrangements for continuity of business.
• Contribution to National Service plan.
• Financial transition planning process established.
• Integration of Agency websites to ensure continuity.
Specialist Agencies to be Part of
HSE
• Comhairle na
nOspideal and Hospital
Bodies Administrative
Bureau.
• HSEA
• GMS (Payments)
Board.
• HeBe
• OHM
• NDSC
• NHO
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HR
Shared Services
CMOD
CMOD/HR
Population Health
Finance Functions
• Financial Planning.
• Statutory Financial Reporting and Treasury
Management.
• Financial Reporting, Control & Policy
Development.
• Evaluation, Costing & Contracting.
• Leading FISP Development.
• Procurement & Value For Money.
Finance Directorate
• Ensuring HSE’s immediate financial management
needs are capable of being delivered from January
2005.
• Resources deployed at appropriate levels to support
managers & clinicians.
• FISP will ultimately deliver enhanced financial
management for HSE nationally.
• FISP will facilitate the delivery of high volume
transaction processing via the National Shared
Services Directorate.
Information & Communications
Technology (ICT)
• Strategic ICT planning and
management.
• ICT architecture, policies, standards
and methods.
• ICT programme/projects management.
ICT Structure
• Corporate ICT directorate in Naas
– Dealing with strategic elements, overall
leadership, policies & standards.
• Operational shared elements through Shared
Services.
• Non- shared elements delivered at local
level.