The Minister for Health Dr James Reilly has today published the Health Service Executive (Governance) Bill 2012. The legislation, approved by the Cabinet yesterday (Tuesday 11th July), will pave the way for major changes in the design of our health services. “For too long the treatment of patients in our health services has had to conform to the needs of the system” said Dr Reilly “this new Directorate structure in the HSE will allow us to redesign the system to put the needs of the patient front and centre”.
The legislation will allow the putting in place of a Director General and six new Directorates, closely aligned to specific areas of service such as primary care, mental health, hospitals and more. The new structure will allow a reorganisation of services to prepare the way for the wider introduction of the ‘money follows the patient principle’ and the ultimate introduction of Universal Health Insurance.
“This Government inherited a two tier health system which is inherently unfair to many citizens. Today’s announcement is a significant step on the road to the abolition of our two tier health system and its replacement with a system that responds to our needs and not our financial means”.
Purpose of Bill
The Health Service Executive (Governance) Bill 2012 will:
(i) abolish the Board structure of the Health Service Executive
(HSE) and provide for a Directorate to be the new governing body for the HSE in place of the Board, headed by a Director General;
(ii) provide for further accountability arrangements for the HSE;
and
(iii) provide for related matters including a number of technical amendments to take account of the replacement of the Board structure by the Directorate structure.
No change to legal basis of the HSE
The legal status of the HSE under the Health Act 2004 does not change under the Bill and HSE employees will remain the employees of the HSE. .
Background
In line with health reform policy, the Bill is intended to:
(i) make the HSE more directly accountable to the Minister for Health, who in turn is accountable to the people through the Oireachtas; and
(ii) help prepare the service delivery for the next phase of the health reform programme.
Provisions in the Bill build on existing accountability arrangements under the Health Act 2004.
Directorate
Under the Bill, the Directorate will consist of a Director General and other directors. The legislation provides for an alteration to number of Directors if later required. The Director General will be a member - and chairperson - of the Directorate.
The Directorate will be accountable to the Minister for the performance of the HSE’s functions as well as its own. As chairperson, the Director General will account to the Minister on behalf of the Directorate in regard to how the HSE’s functions are performed. He or she will do this through the Secretary General of the Department of Health.
How things will work
The HSE has responsibility for the organisation and delivery of health services and the Directorate will be accountable to the Minister for the performance of HSE functions – it will have to explain its decisions.
The Bill allows the Minister to issue directions to the HSE on the implementation of Ministerial and Government policies and objectives relating to HSE functions where the Minister believes that the HSE is not having sufficient regard to such objectives or policies in performing its functions.
The Minister will also be empowered to specify priorities for the HSE which the HSE must have regard to in preparing its service plan.
The Minister may establish performance targets for the HSE in regard to these priorities. Directions, priorities and targets won’t be made in relation to individual patients or service users.
Outside the Bill
In anticipation of the legislative changes, the Minister intends that the HSE would recruit and appoint heads of health & wellbeing, hospitals, primary care, mental health and social care. It is envisaged that employees heading up these service areas and children’s services will be appointed as members of the Directorate.
Wider Context
The Directorate is a transitional, interim move. Transitional governing arrangement needed in the HSE to prepare health service delivery systems for the next phase of the health reform programme.
As the health reform programme advances, the HSE will eventually no longer exist as its functions move elsewhere. This will take careful planning and sequencing and further legislation