THE MINISTER for Health James Reilly is seeking to put in place transitional arrangements as a “matter of urgency” for the establishment of new groups of public hospitals with revised governance arrangements.
The moves form part of the plan set out in the programme for government to transform public hospitals into not-for-profit trusts with managers accountable to their own boards.
In an internal letter sent last week to the chief executive of the HSE Cathal Magee, the secretary of the Department of Health Michael Scanlan said the Minister had decided to set up hospital groups as quickly as possible this year on an administrative basis.
He said these would have “a single consolidated management team with responsibility for performance and outcomes within a clearly defined budget and employment ceiling for each hospital”.
Mr Scanlan said the Minister had also decided the executive team for each hospital group would be given “the autonomy to reconfigure services across the group subject to an agreed policy framework and approval process”.
He said Dr Reilly also wanted administrative “boards” to be established for each of these hospital groups and for the Public Appointment Service to be asked to select individuals for appointment as non-executive members.
Mr Scanlan’s letter said that “these arrangements reflect and build on recent changes in the governance of Tallaght hospital and the midwest and Galway hospital groups”.
He said the Minister believed a small group of officials from the Department of Health and the HSE “should be asked to identify suitable hospital groups very quickly on the clear understanding that the groupings and their governance arrangements will be reviewed prior to 2015 to ensure an appropriate environment for the introduction of universal health insurance”.
“Arrangements should be developed for appointing suitable people to the key leadership positions such as group CEO, chief financial officer, clinical director, director of nursing and chief operating officer.
“An annual budget and employment ceiling should be developed for each group and the executive team should have the authority to re-deploy staff [including consultants] across the group [where a group involves a HSE and a voluntary hospital, the aim would be to use the service level agreement provision to give the larger hospital the authority to manage the entire group].”
Mr Scanlan said he believed a coherent “investment in people package” would need to be developed to underpin the health reform programme.
“I will be raising this formally with the Department of Public Expenditure and Reform to explore whether they would be willing to give us some autonomy to progress the individual elements of such an initiative on condition it is done within existing budgets and the employment control framework and in compliance with public pay policy.”
The Department of Health said this proposal for an investment in people package was based on the understanding that the reform programme under way within the health services along with the departure of key staff, presented challenges.
“Training and development of staff will be essential to ensure that we have the necessary expertise, for example, the establishment of hospital trusts may require specialised management.
“The department wants to be in a position to take the necessary decisions as the issues arise and, at the very least, get agreement on the overall direction as well as be in a position to engage with staff to drive the change.
“Additional resources are not being sought but rather, an understanding of what will be required to drive the reform programme and the autonomy to make the decisions necessary.”
