THE NEWS that the Health Service Executive (HSE) is close to implementing the first stage of its "National Integration - Local Responsibility" restructuring programme is welcome.
Since its inception in 2004, the HSE has experienced mixed fortunes. It has been overly centralised and, because of patient safety problems most notably a series of breast cancer scandals, there has been a certain loss of public confidence in the organisation's ability to deliver safe and effective healthcare.
With a commitment to creating a new structure of up to nine regional health authorities by the end of the year, the HSE will begin a series of changes designed to make the organisation more responsive to local needs. While the division of responsibilities within each region has yet to be decided, it is clear that each will have a regional director responsible for the provision of health services in that area. The initiative will also facilitate the implementation of a redundancy programme among HSE middle managers.
Prof Brendan Drumm, the chief executive of the HSE, has built his vision for a quality health service around the concept of seamless care for patients. With a perception that quality healthcare must revolve around a hub of acute hospitals, there is a need to alter public expectations by creating a health system that is firmly rooted in the community.
The creation of a number of key posts at national level will be critical to the success of the restructuring plan. Perhaps the most crucial will be that of Director of Integrated Care, on whose shoulders will fall the task of bringing together hospital services and primary care. The ability of the appointee to infuse a vision of seamless care throughout the HSE, leading to the abolition of barriers currently experienced by patients, will be vital. The expected appointment of a senior hospital consultant to the post of Director of Clinical Care and Quality reflects a belief that many of the changes needed in the hospital system will be driven by local clinical directorships as set out in the new consultants' contract.
However, a number of concerns remain to be addressed. Despite rhetoric in favour of the expansion of primary care, the lack of urgency in developing primary care teams to date may reflect a lingering belief within the higher echelons of the HSE that the most important objective is simply to decant both patients and services from the hospital system. This would be a grave mistake. True integration requires the development of a comprehensive community health service, with the appointment of healthcare professionals who will work simultaneously in hospital and primary care. And while patient safety can never be absolutely guaranteed, the HSE must demonstrate a proactive approach to the problem if it is to regain public confidence.
But the single greatest barometer of future success will be the HSE's performance at local level. It must be seen to resource each area even-handedly, so that a person with diabetes, heart disease or a psychological illness will experience equal access and be offered the same treatment wherever they live.