The Struggle to Achieve a Coherent Approach to Organisational and Sectoral Governance ACESA Breakfast Briefing Chester Beatty Library 20th April, 2016 Jim Breslin Secretary General Department of Health

Central Government’s own Governance Responsibilities

Department of Health – Governance Challenges

Public Value What is our vision for our organisation’s contribution to population health?

Public Value - Department’s Role Leadership and policy direction for the health sector to improve health outcomes Governance and performance oversight to ensure accountable and high quality services Collaboration to achieve health priorities and contribute to wider social and economic goals An organisational environment where, on an ongoing basis, high performance is achieved and the knowledge and skills of staff are developed

Role 1: Leadership and Policy Direction - Agency Alignment

1. Leadership and Policy Direction - Agency Alignment

1. Leadership and Policy Direction - Agency Alignment? National Women & Infants Health Programme

1. Leadership and Policy Direction - Agency Alignment Objective Department a prime mover* lead in the analysis, development, communication & review of policy and legislation represent Ireland and the health system at international level promote evidence-based policy making, innovation and the public interest *Prime mover = that muscle which is primarily responsible for producing a particular movement but as part of Wider Health System* but fully leverage the knowledge, skills and support of the entire health system ensure international evidence influences the development & implementation of Irish health policy promote and monitor system progress in achieving health and social outcomes * System = a set or series of interconnected or interdependent parts or entities (objects, organs, or organisms) that act together in a common purpose or produce results impossible by action of one alone.

Role 2: Governance & Performance Oversight Lead in the design and architecture of the whole health sector Set and communicate priorities and performance standards Lead the negotiation of resources and ensure they are allocated to achieve value for money Implement performance oversight systems and techniques

2. Governance and Performance Oversight – System Architecture Design

2. Governance and Performance Oversight: Set priorities and performance standards - “Define the good” Section 41 Child and Family Agency Act 2013 The Minister shall develop a performance framework (“Performance Framework”) to provide the Agency with policy guidance, direction and prioritisation parameters for the preparation of its corporate plan. Section 44 CFA Act 2013 The Minister shall develop an annual performance statement (“Performance Statement”) to provide the Agency with specific policy guidance, direction, prioritisation and resource parameters in respect of each year for the preparation of its annual business plan.

Role 3: Collaboration Collaborate across sectors, departments and stakeholders to promote a healthy Ireland… Promote the economic contribution of a healthy population and the health service… Contribute to whole-of-Government approaches to major social and economic priorities

Department of Health – Governance Challenges

Legitimacy & Support How do we ensure that through our priorities we generate legitimacy and support? How do we address the priorities of our stakeholders?

Strategy Statement, Department of Health Annual Report, 2015

More Broadly – Health Achievements…

Some Advertising!

Advertising Continued! Breast and Colorectal cancer improvements [5-Yr Relative Survival Rates To ] Breast Cancer – up from 75.8% to 81.5% Colorectal – up from 51% to 60.3% Meningitis C down from: 130 cases (1999) to 6 (2014)

More Advertising… Ireland 2nd in Europe for Tobacco Control measures: work-place smoking ban (2004) ban on packets < 20 cigs (2007) all tobacco products stored within closed container, only retailer access (2009) graphic warnings (2013) ban on smoking in cars where children present (2016) Ireland Smoking down! ( ) Smoking Down! Adults 33% → 23% Kids (10-17 yrs) 21% → 8%

Some More Advertising… Inpatient & Day Cases 54% increase in day case procedures - 558,813 to 860,763 Inpatient procedures constant – approx 600,000 p.a. [above from 2006 – 2014] Cost per weighted unit of care fell from 2008 to 2014 by 19% (inpatient), 18.7% (day case) Day of Surgery Aadmission rate increased 9% older psychiatric hospitals have either been completely closed or have closed to new admissions.

Just a little bit more advertising… GP care without fees - Approx. 800,000 people in the over-70s and under-6 age cohorts GMS Diabetes cycle of care - 63,000 patients registered by end 2015

Some progress but nowhere near enough to address delivery challenges Significant delivery challenge experienced 3 deliverables (3%)

End of the advertising Significant delivery challenge experienced 3 deliverables (3%)

Department of Health – Governance Challenges

Organisational Capacity Also DoH Role 4: High Performance Organisational Environment Working Better Together organisational change programme established in 2015 New organisational design implemented Q Projects Group established involving ⅓ of Department’s staff Project Groups recommendations on how we adapt our work to meet the needs of a modern, open and value-driven Department of Health.

Working Better Together – Priority Improvements 1.Integrated approach to business planning and risk management, in the context of the common corporate governance standard 2.High performance work environment through better learning and development and people management 3.Improved corporate support services, including knowledge management 4.Better performance dialogue with the HSE and other health agencies 5.Improved organisational arrangements in respect of professional regulation 6.Enhanced policy development 7.Strengthened internal communications 8.Stronger collaboration within the health sector and cross-sectorally 9.Better, more stream-lined parliamentary work

Achieving Improved Organisational & Sectoral Governance in the Public Service Place public service (health care values) at the centre Radically reform operating models to cope with growing demands, utilise technology & empower the public Lead higher performing, more accountable organisations Deliver credible operational improvements today

Specifically for Health? Public value proposition based upon accelerated evolution from episodic, reactive & fragmented health service response to growing age and chronic illness related demands to population health models of care with greater integration, continuity & coordination of care. Legitimacy & Support through near term operational improvements to address access issues. Organisational Capacity improved through DoH and HSE organisational change; governance/legislative reforms; stronger Integrated Care Programme capability (independent of structure) and more devolved decision making and accountability to Hospital Groups and Community Health Organisations

Thank you!