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Irish Government's proposed healthcare structure raises serious questions about efficiency, integration, prevention etc.

The Government has decided on the structure of the healthcare system which is to follow the dissolution of the HSE. The full Government statement is reproduced below. There are serious questions that arise from the structure proposed by Government. Will it be more efficient than the HSE? Will it deliver an integrated system? Will it give priority to the development of REAL Primary Care Teams.
Cabinet approves drafting of legislation for new HSE governance – December 20, 2011The Government has today (December 20, 2011) approved the drafting of legislation involving significant changes in the governance in the Health Service Executive.
The legislation, once implemented, will replace the current Board /Chief Executive structure with a Directorate (or Transitional Governance Structure)b
The Government is committed to a radical reform of the health services which will see the introduction of Universal Health Insurance (UHI). The putting in place of a new Directorate in the HSE is a key component in the move towards UHI.
The Programme for Government commits to the HSE ceasing to exist over time. This legislative change is the first step in a process of transformation which will require detailed planning. This initial step is designed to avoid disruptive change at a difficult and challenging time for health and social services. Legislation which will have the cumulative effect of abolishing the HSE will be brought forward on a sequential basis, as part of the overall health reform programme, with functions transferring elsewhere as part of the move towards a system of Universal Health Insurance. In addition, functions relating to child protection will transfer from the HSE to the proposed new Children and Families Support Agency.
Purchaser of Services – Provider of Services
This fundamental alteration of the operation of the health services will see an organisational division between those assets charged with purchasing health/social services and those assets charged with providing the health/social services. This in turn will allow the implementation of a full ‘Money Follows the Patient’ system where providers are paid on the basis of services delivered. It is the view of Government that the interests of citizens in securing high quality health care in an effective, efficient manner will be best achieved in this way.
In order to achieve a new degree of transparency, accountability and efficiency – prior to its abolition – the HSE will be re-organised along Service Lines. The new Directorate structure involves the identification of clear areas of priority and the establishment of responsible directors for those Service Lines.
Seven Directors
The following seven areas will be the subject of a Directorship: -
Hospital Care, Primary Care, Mental Health, Children and Family Services, Social Care, Public Health and Corporate/Shared Services.
Seven key individuals will be appointed as Directors, one of the seven will be appointed as the Director General. The Minister for Health will determine the precise functions of the Directors.
The Minister will bring forward detailed proposals at a later date for the re-organisation of the HSE at the directorate, regional and local level in a manner which facilitates a smooth transition from the current structure to the structures required under UHI.
Clarity, accountability
The purpose of this new Directorate team will be twofold; to run the health services as they exist and to prepare for the transformation required in the move to Universal Health Insurance.
The clear identification of the seven directorates or seven Service Lines will provide (as already alluded to) considerable clarity related to the delivery of the relevant services under the responsibility of the Directors and greater financial transparency and accountability in assessing those services.
It is proposed that the persons to take up the Directorates will be a combination of re-assigning existing HSE directors as well assigning persons to be identified by internal competition.
Priority Legislation
 The legislation to give effect to these changes will be given a clear priority by the Government in the New Year. With the passing of the legislation the Minister for Health will provide a clear statement on the precise timeline for further reform in the run up to UHI.
Other related developments
A White Paper setting out how UHI will be implemented will be published before the end of next year.
The Primary Care Fund, as provided for in the Programme for Government, will be established as a matter of priority. Its early establishment will support the roll-out of free GP care beginning in 2012. The Integrated Care Agency and the Hospital Care Purchase Agency, which are likewise provided for in the Programme for Government, will also be established during 2012.

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