THE EXISTING system of administering hospital and community healthcare services separately is to be abolished under reforms planned by the Health Service Executive (HSE).
In their place a new devolved structure will be created under which regional directors will be given power to deliver an integrated healthcare service in their area.
The new regional directors will also be given authority for the healthcare budget in their locality and they will decide on how the money should be divided up between hospital, primary care, mental health and other sectors.
Under the new plans the Department of Health and the HSE at national level will make healthcare policy and set national standards, while the new regional directors will implement it at local level.
The number of proposed new healthcare regions to be established remains unclear, with some sources indicating that there will be four and others suggesting that it could be as many as eight.
It is understood the HSE believes that the new proposals could lead to a streamlining of management levels in the organisation which have been strongly criticised in recent times.
The proposals, which have been considered by Ministers in recent weeks, were set out for trade union leaders yesterday.
HSE national director for human resources Sean McGrath said that the proposed modifications "will be introduced in a planned and measured way over the coming 18 months or so".
The plan, however, represents the second major reform of health service structures within five years. Under changes introduced by the Government in 2004, the former 11 health boards were abolished and replaced by a single unified Health Service Executive which was charged with administering and delivering public healthcare services on a national basis.
It currently has a budget of more than €14 billion per year.
Under the current arrangements hospitals are administered separately from primary, community and continuing care services in twin vertical "pillars".
The system has been widely criticised as being overly bureaucratic and too highly centralised.
Earlier this year the official report on the cancer controversy in Portlaoise spoke of staff being confused as to whom they reported to under the current arrangements - an issue that was raised by Minister for Health Mary Harney yesterday in defending the new changes.
In a statement yesterday the HSE said its planned "modifications" would "facilitate more local responsibility and authority and strengthen area structures within the national umbrella of the HSE".
"They will enable more clinical involvement in the design and management of patient services which will be a key driver in the enhancement of the quality of patient services," it said.
Under the proposals there will also be significant changes to the HSE's top level management team.
The posts of national director of the National Hospitals Office and of Primary, Continuing and Community Care will be abolished. These will be replaced by a single head of integrated services.
The post of national director for population health, which is largely responsible for public health issues, is also to go and be subsumed into a new directorate of planning.
The HSE is also to appoint a new national director for communications as well a new national clinical director who will co-ordinate and work with new hospital clinical directors who are to be appointed under the terms of the revised consultants contract.
Unions said yesterday they would welcome any move that improved the situation for patients.
However Kevin Callinan of Impact said they were sceptical given their past experience of dealing with the HSE.
Donal Duffy of the Irish Hospital Consultants Association criticised the plan, saying it would lead to the creation of more managers.
Some health service sources have said the new plan could facilitate the implementation of a controversial voluntary redundancy scheme for up to 1,000 healthcare staff, which the HSE proposed to the Government earlier this year.
