Health service reform

HEALTH Minister Dr James Reilly has taken a lot of flack because of ongoing problems in the health service but he’s entitled to some plaudits this week for putting the wheels in motion to draft legislation that will involve major changes in the governance of the HSE.

On implementation, the legislation will replace the current board/chief executive structure with a directorate or transitional governance structure. This is an important first step towards a radical reform of the health service, which will see the abolition of the HSE and the introduction of Universal Health Insurance (UHI), which was outlined in the Programme for Government.
This week’s Cabinet approval to draft new health measures came on the same day that Dr Frank Dolphin announced he is stepping down as the chairman of the interim board of the HSE. He was appointed chairman of the HSE in July 2010 but remained on, at Dr Reilly’s request, as interim board chairman to assist with the planned changes.
Michael Scanlan, the secretary general of the Department of Health, will replace Dr Dunlop as interim board chairman.
The Government is determined to streamline the health service to eliminate unnecessary overlap and waste of valuable resources by various units within the HSE. The change of approach will see organisational division between those assets charged with purchasing health/social services and those assets charged with providing the health/social services.
This structure is paving the way for what is termed a “money follows the patient” system, where providers are paid on the basis of services delivered. The Government believes the interests of citizens in securing high-quality health care in an effective, efficient manner will be best achieved in this way.
Before it is consigned to history, the HSE will have a final hurrah. If they display flair and imagination, the team of seven directors charged with heading hospital care, primary care, mental health, children and family services, social care, public health and corporate/shared services could help restore some confidence in our health system. One of the seven will be director general and Minister Reilly will specify the detailed brief for each director. The Government maintains the clear identification of the seven directorates or seven service lines will provide 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.
The new directors will be a combination of re-assigning existing HSE directors, as well as new people selected by internal competition.
Meanwhile, the Government has given an assurance that a White Paper setting out how UHI will be implemented will be published before the end of next year. Also, the Primary Care Fund, as provided for in the Programme for Government, is to be established as a matter of priority. Its early establishment will support the rollout 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.
While the proper functioning of regional, general and community hospitals are under serious threat due to funding cuts and staff levels are plummeting to dangerously low levels in some institutions – problems compounded by the recent budget – perhaps this week’s announcement might suggest light at the end of the tunnel. However, until the purse strings begin to loosen, all that people can cling to is hope.

The spirit of Christmas
AS we pass the winter solstice, which marks the shortest day of the year and was revered in many pre-Christian cultures, we look forward to Sunday and what is probably the most celebrated of all religious festivals, Christmas Day.
December 25 was chosen as Jesus’ birthday to offset pagan solstice celebrations but now in more enlightened times we can appreciate the significance of both dates. The solstice has long been the subject of astronomical and archaeological investigation and provides an insight to the knowledge and skills of ancient civilisations across the globe, including here in Ireland.
Christmas Day speaks to everybody, even those of non-Christian faiths. The messages of love, peace and hope associated with Christmas are universal.
The reason the spirit of Christmas has endured is that it centres on the birth of an infant 2,000 years ago, which was recognised even then as something of enormous significance. The shepherds, and later the wise men from the east, came to the manger in Bethlehem to pay Him homage as the Saviour born on earth.
In the Christian tradition, Joseph and Mary are also central to the first Christmas story, when Jesus’ birth completed the Holy Family. Family is at the heart of Christmas and this is why it is also child-centred.
There is something special about family reunions at Christmas, sons or daughters, or indeed close relatives, travelling long distances, especially from overseas, to complete the family unit.
Given that, due to the economic recession, we have so many of our younger generation overseas, we should spare a thought for those who cannot enjoy the warmth of such reunions.
Christmas without family does not have the same sparkle. Parties, glitz, glamour and all the presents in the world do not compensate for not being among family at Christmas. On this note, we should spare a thought for those living alone, the homeless, those who feel isolated because of illness or those who feel marginalised in any other way.
We should try to ensure that somehow the spirit of Christmas touches these people. If this cannot be achieved by direct contact, another option would be to support any one of the many voluntary agencies or care groups that help the most vulnerable in society.
Everybody deserves a happy Christmas.