Voluntary hospitals and agencies will come under a new Eastern Regional Health Authority, which will replace the Eastern Health Board under legislation to be introduced in the Oireachtas shortly.
The Bill, which follows the recommendations of the Task Force on the Eastern Regional Health Authority, also provides for three Area Health Boards within the region, which will oversee the delivery of health services.
The Minister for Health, Mr Cowen, yesterday published the Health (Eastern Regional Health Authority) Bill, which provides for the reorganisation of the delivery of health services in Dublin, Kildare and Wicklow, an area containing 1.3 million people.
He described the proposals in it as "the most significant reform of health service structures since the establishment of the health boards in 1971".
At present health and many social services in the area come under the aegis of the Eastern Health Board, which is responsible for six times more people than the Midland Health Board (with a population of 205,000) and almost three times more than the Southern Health Board, which includes Cork city and has 546,000 people.
However, most hospitals in the eastern region do not come under the responsibility of the Eastern Health Board. Major teaching hospitals such as St James's, St Vincent's, the Mater, Beaumont and Tallaght, the three maternity hospitals, all in Dublin, and a number of smaller hospitals, including those with national specialities like the National Rehabilitation Hospital in Dun Laoghaire, are all voluntary. Up to now they have been funded directly by the Department of Health.
The only hospitals run and funded by the Eastern Health Board are the James Connolly Memorial hospital in Blanchardstown, St Colmcille's Hospital at Loughlinstown, and Naas General.
This imbalance is reflected in the employee numbers, with twice as many people working for voluntary bodies as work directly for the health board. The voluntary hospitals in the region employ 15,000 people, compared with 9,000 working for the Eastern Health Board. Other voluntary agencies employ 3,000.
Mr Cowen said yesterday that the Bill would reorganise the structures in the region to bring the delivery of health and personal social services closer to the people. It would facilitate more involvement by local communities in the planning and organisation of their health services.
It would also ensure that the £1.2 billion spent annually by the taxpayer on health services for the region would provide the best possible value for money, he said. All service provision in the region would be on the basis of a written, legally-binding service agreement between the authority and the service provider.
The Eastern Regional Health Authority will focus on the strategic planning of services for the region and the commissioning of those services from both the statutory and voluntary sectors. It will oversee and evaluate the services provided, covering primary care, acute care and community care.
"It will bring about a reorientation of the services, so that all services are integrated around the patient and seamless in the perception of the user," he said.
Referring to the service agreements, the Minister said this would end the system where the voluntary hospitals and agencies operated outside the health board system and were funded directly by the Department of Health, and tie them into the overall services for the region for the first time.
This would allow them to retain their operational autonomy, while making them fully accountable for the public funds they receive. He said this did not represent an intention on his part or that of the Government to "take over" the voluntary hospitals.
The authority will not be directly involved in the delivery of services. This will be the responsibility of three Area Health Boards, the Northern, the South-Western and the East Coast. They will take over the services currently provided by the Eastern Health Board and plan and co-ordinate all services in co-operation with the local voluntary service providers.
Membership of the new authority will resemble that of the health board, with an overall membership of 55. Of these 30 will be public representatives nominated by local authorities in the region, 13 will be registered health professionals, nine representatives of the voluntary sector and three nominees of the Minister.
While the regional chief executive will, like the area chief executives, be appointed through the Local Appointments Commission, the first regional chief executive will be appointed directly by the Minister for a period of three years.
Mr Cowen reassured staff working for the Eastern Health Board that their terms and conditions of employment would be fully protected when the board is dissolved on the establishment of the new authority. The staff will be assigned to one of the three area health boards.
The implementation of the proposals will be directed by a task force under the chairmanship of Mr Donal O'Shea, CEO of the Northern Eastern Health Board, who chaired the task force which made the recommendations.
Mr Cowen said he hoped that, if the Oireachtas approved the Bill within the next two months, the authority could be established next September, and take over full financial responsibility for the services from the fiscal year 2000.