1. The History of the Irish Health Service

2. History Irish health service Past structures – History of the health service Current structures – Analysis of current situation

3. History of the Irish health service Key dates – Health services in Ireland began in the 18th century in the voluntary, philanthropic and private sector – First hospitals in the 1720s – 1924- Dept Local Govt and Health established – 1947 establishment of Department of Health

4. Key dates continued – 1970 Health Act: Established 8 Health Boards – 1994- Shaping a Healthier Future strategy – 1998 Dept of Health and Children – 2004 – Health Act, establishing HSE

5. History of health services in Ireland 1970 – Heath service removed from local authority & reorganised as 8 regional heath authorities under DOH 3 areas hospital; service, special or psychiatric, and community care Later 1990’s EHB subdivided into 3 smaller boards (northern, south-western, east ) 11 health boards in total

6. Organisation of health services 2 nd major change followed Prospectus report 2003 Reorganisation of Health Service – unified, streamlined Abolish 11 health boards Single national health service HSE HSE – Policy, administration, managing HS Abolish local responsibility –Minister for Health and Children responsible for Health Service The decision of the Government to replace all these agencies with the HSE signalled the start of a new era in Irish health care.

7. Why change? The establishment of the HSE represents the beginning of the largest programme of change ever undertaken in the Irish public service. Prior to this our health care services were delivered through a range of different agencies, each of which was independently answerable to the Department of Health and Children. It was a complex structure that made it difficult to provide nationally consistent health services.

8. Health reform programme An increase of 8.2 per cent over the 5 year intercensal period, an annual average increase of 1.6 per cent. There are now 4.58 million people living in Ireland, the highest since 1861 according to CSO 2011. Forecast that this will increase beyond 5 million in 10 years. Compared with our European neighbours we have a relatively young population; just 10% is over 65. However, in 30 years, 20% of the population will be over 65 and 40% will be over 50

9. An introduction to the HSE The Health Service Executive (HSE) was established in January 2005 as the single body responsible for meeting Ireland’s health and social care needs. These services range from public health nurses treating older people in the community to caring for children with challenging behaviour from educating people how to live healthier lives, to performing highly-complex surgery; From planning for major emergencies, to controlling the spread of infectious diseases.

10. HSE Cathal Magee – Chief Executive Officer intention to step down in July 2012 Tony O’Brien, Deputy CEO

11. About the HSE The Health Service Executive (HSE) is responsible for providing Health and Personal Social Services for everyone living in the Republic of Ireland. It is the largest organisation in the State, employing over 130,000 people, with a budget of €14.7 billion There is a target to reduce costs by €750m in 2012. Staff levels have reduced by over 8,700 since the peak employment levels in 2007 This is despite the fact that the health budget has been increasing rapidly from €3.7 billion in 1997 to a budget of €13.317bn in 2012. The HSE was set up as part of the provisions of the Health Act, 2004, which states the objective of the HSE is to provide services that improve, promote and protect the health and welfare of the public. Health Act, 2004

12. HSE Structure The HSE manages services through a structure designed to put patients and clients at the centre of the organisation. It has 3 clearly defined interdependent areas - Health and Personal Social Services, Support Services and Reform & Innovation. All of the services provided by the HSE to the public are delivered through four Administrative Areas - Dublin Mid- Leinster, Dublin North-East, West, and South. Health and Personal Social Services are divided into 3 service delivery units: Population Health promotes and protects the health of the entire population; Primary, Community and Continuing Care (PCCC) delivers health and personal social services in the community and other settings; National Hospitals Office (NHO) provides acute hospital and ambulance services throughout the country.

13. HSE Structure Source: Harvey 2007

14. Drivers of change Social Change: Society demands greater efficiency Increased patient choice in the health care system Public more informed

15. Drivers of change Political Change: Quality and Fairness The Health Service Reform Programme

16. Drivers of change Professional Change: Commission on Nursing (1998) Report on Nursing Management Competencies (2000) Agenda for the Future Development of Nursing and Midwifery (2003)

17. Drivers of change Technological Change: IT gives opportunity to modernise development of electronic staff records, time & attendance systems, electronic rostering and patient acuity systems.

18. Drivers of change Organisational Change: Drive for greater empowerment of workforce; Need to proceed on a partnership basis.

19. Background to recent health reforms Recent reports feeding into reform programme – Commission on Financial Management and Control Systems in the Health Service “Brennan Report” January 2003 – Audit of Structures and Functions in the Health System “Prospectus Report” 2003 – Report of the National Task Force on Medical Staffing “Hanly Report” 2003

20. “Brennan Report” 2003 Focus on financial management and control systems- but ”problem is fundamentally structural” Problems – non-unified management system, no incentives for cost-effectiveness, no cost-consciousness for decision-makers re resources, insufficient evaluation, poor investment in info and management systems Core principles – National system, accountability with spenders, costs allocated to patients, control is wider than finance function

21. Brennan report Recommendations (136) include: – Establish a national managing Executive – New consultant contracts- exclusively public sector – Evaluation of funded drug schemes – Reform of medical card scheme

22. Hanly Report 2003 Background: – European Working Time Directive Reduce junior doctors hours max of to 48 per week by 2009 (58 by 2004 and not >13 hrs per day, 56 by 2007) Task Force established February 2002 to devise a plan to implement this (current average of 75 hours) Related recommendations: – Consultant-provided service – Reform of medical education and training

23. Prospectus Report 2003 Major reforms include – Establishment of a Health Service Executive – Reorganisation of health agencies A “new health system architecture” – Simpler governance and greater accountability Increase consumer involvement in decision- making and delivery Health Information and Quality Authority

24. HIQA A key policy aim of the Health Strategy, Quality and Fairness (2001) is to deliver high quality services that are based on evidence supported best practice. The Health Information and Quality Authority is the first truly independent Authority working to assure that Ireland's health services are delivered to world class standards. The Health Information and Quality Authority was established in May 2007 as part of the government's health reform programme. HIQA is an independent Authority, with broad ranging functions and powers reporting to the Minister for Health.

25. Progress HIQA HIQA has been set up to drive quality, safety, accountability and the best use of resources in our health HIQA will set the standards for delivering health and social care services and will continuously inspect to ensure that these standards are being met. HIQA will take action if there's a risk to the safety of any person using our health services. Inspection reports will be published so that the public can make informed choices when seeking care. HIQA will help deliver value for money by monitoring that the resources in our health and social services are used in a way which delivers the best outcome for the patient or service user.

26. Progress The key areas of responsibility for HIQA will be: Developing health information systems; Promoting and implementing structured programmes of quality assurance; Overseeing accreditation; Developing health technology assessment Reviewing and reporting on selected services.

27. Exercise Look up the following websites www.hse.iewww.hse.ie www.dohc.ie Find a recent publication and bring a summary of what you found to class to discuss

28. References Harvey B. (2007) Evolution of Health Services and Health Policy in Ireland. Combat Poverty Agency: Dublin Government of Ireland (2012) This is Ireland. Highlights from Census 2011, Part 1. The Stationery Office, Dublin www.cso.ie www.dohc.ie www.hse.ie