Hospitals across the State are to be grouped into four networks under new plans to be finalised by the board of the Health Service Executive (HSE) when it meets tomorrow.
The move, which is likely to prove controversial, will see hospitals in Limerick, Galway and Donegal, for example, being managed as one network.
The change is being mooted just months after a different set of hospital structures was agreed by the HSE. In June an HSE newsletter set out to "introduce" its "newly appointed senior managers" including the managers of 10 hospital networks who had recently been appointed. Seven of the managers had been appointed full-time and three others in an acting capacity.
The HSE said then that its National Hospitals Office would manage and co-ordinate the delivery of acute hospital services through these 10 hospital networks, which generally covered the same territory as the former health board regions.
The HSE, when asked about the change of direction yesterday, said its chief executive Prof Brendan Drumm planned to make the HSE's management structures more responsive to the needs of patients and frontline staff.
"The plan simplifies a number of key management functions. For patients and frontline staff the changes should mean more integration, consistency and accountability. Reporting structures for the vast majority of staff will remain unchanged," it said.
An HSE member who contacted The Irish Times about the new network plan predicted an uproar. The source said there were concerns, for example, that Limerick Regional Hospital would become "subservient" to Galway's University College Hospital and would effectively be "downgraded".
The source described the changes proposed as the implementation of the Hanly report and more. "It wouldn't just be Ennis and Nenagh General Hospitals that would be downgraded," the source predicted.
"I was in favour of Hanly, but I think this is just a step too far. I think there will be a significant outcry."
The boundaries for the four new hospital networks are the same as for the four regions of the HSE. They are the Western, Southern, Dublin/North-East and Dublin/Mid-Leinster regions, with headquarters in Galway, Cork, Kells and Tullamore.
The Western region stretches from Limerick to the Inishowen peninsula; the Southern region covers the entire south of the country from Kerry to Wexford; the Dublin/Mid-Leinster area covers the midlands, Wicklow and parts of south and west Dublin; and the Dublin/North-East region covers from north Dublin to Cavan and Monaghan.
The idea is to make each region self-sufficient in the provision of health services.
The roles of up to 12 smaller hospitals in these networks are being clarified.
The HSE said the changes were designed to accelerate the pace of the reform programme; to involve clinical practitioners and patients in the development, execution and monitoring of health care strategies; and to ensure full integration between the main service delivery units in the HSE.