The Minister for Health, Dr. James Reilly TD today (Tuesday, 14 May, 2013) announced a reorganisation of public hospitals into more efficient and accountable hospital groups that will deliver improved outcomes for patients. This represents the most fundamental reform of the Irish acute hospital system in decades.
The Government’s decision regarding the establishment and operation of the new hospital groups was informed by two reports – ‘The Establishment of Hospital Groups as a Transition to Independent Hospital Trusts’, produced by an expert group led by Professor John Higgins following consultation with stakeholders, and ‘The Framework for Development – Securing the Future of Smaller Hospitals’. Both reports were published today. These reports fulfil important commitments in Future Health, the strategic framework for reform of the health service which was published last November.
By working in groups, hospital services will be provided by the hospitals in each group, based on the evidence based needs of their populations. Each group of hospitals will work together as single cohesive entities managed as one, to provide acute care for patients in their area, integrating with community and primary care. This will maximise the amount of care delivered locally, whilst ensuring complex care is safely provided in larger hospitals. Six hospital groups will be established as follows:
· Dublin North East;
· Dublin Midlands;
· Dublin East;
· South/South West;
· West/North West;
Each group will comprise between six and eleven hospitals and will include at least one major teaching hospital. Each grouping will also include a primary academic partner in order to stimulate a culture of learning and openness to change within the hospital group. Robust governance and management structures will be put in place at group level.
Benefits for Patients
The objectives of the groups are to:
· achieve the highest standard of quality and uniformity in hospital care across the group;
· deliver cost effective hospital care in a timely and sustainable manner;
· encourage and support clinical and managerial leaders;
· ensure high standards of governance, both clinical and corporate and recruit and retain high quality nurses, NCHDs, consultants, allied health professionals and administrators in all our hospitals.
The introduction of groups will provide for organisational change in the first instance, giving more autonomy and better enabling the reorganisation of services in a well-planned manner. Over time, this will help to improve services and deliver better outcomes for patients.
Speaking at the launch, Minister Reilly said: “The establishment of hospital groups signals a fundamental modernisation of our health system organisation in line with best international practice. The new hospital groups, each with their own governance and management, have been designed so as to provide the optimal configuration for hospitals to deliver high-quality, safe patient care which is cost effective and guarantees better outcomes for patients.”
Framework for Smaller Hospitals
The Framework for Smaller Hospitals outlines the need for smaller hospitals and larger hospitals to operate together and is therefore intrinsically linked to the formation of sustainable hospital groups. Better co-operation between hospitals will help to maximise the amount of care delivered locally.
Speaking on this issue, the Minister said: “Hospital groups will secure the future of our smaller hospitals. When the new groups are established, services can be exchanged between sites. This will result in the maintenance of activity in smaller hospitals and will allow them to focus on the provision of care that is safe and appropriate”.
Next Steps – Implementation
To complement implementation of the Report’s recommendations, the Department of Health will now put in place an overarching policy framework to guide overall hospital services reorganisation from a national standpoint. Work on the roll-out of hospital groups will commence immediately and will be overseen by a National Strategic Advisory Group and driven by the HSE. Group Chairpersons and CEOs will be appointed as soon as possible and preliminary governance arrangements will be put in place.
Initially the groups will be established on a non-statutory administrative basis. Each group must develop a strategic plan for their future service configuration in the first year of their operation. These plans must describe how they will provide more efficient and effective patient services; how they will reorganise these services to provide optimal care to the populations they serve; and how they will achieve maximum integration and synergy with other groups and all other health services, particularly primary care and community care services.
Following a rigorous evaluation of each group to ensure it is fit for purpose to function as a Hospital Trust, legislation will be put in place in 2015 to enable Independent Hospital Trusts to be established, taking account of any changes to groups which may emerge from the review process.
The Minister said: “I am very pleased that Professor Higgins has agreed to stay on until the end of June to work on the initial implementation phase in the establishment of the groups. He will return to his work in Cork but will continue to play a part in overseeing implementation as a member of the National Strategic Advisory Group. Today represents a major milestone in the Government’s health reform programme. I would like to thank Professor Higgins, the Strategic Board and the Project Team as well as those who participated in consultations. I look forward to working with all of the stakeholders to implement hospital groups so that we can deliver the best possible service for patients.”
Professor Higgins said: “We have a wonderful opportunity to make a step change within the Irish hospital system. We need to draw down the enthusiasm, the expertise and the experience of our all our staff. Working together we can deliver real change.”
Tony O’Brien, HSE Director General Designate said: “Today’s announcement is the most significant development in the organisation of our hospital services since the development of the cancer centres. This is an ambitious and well considered step towards ensuring that Ireland has a high quality, well organised and cost effective framework for the provision of acute hospital services to meet the changing needs of our population. Today marks the beginning of a journey towards a new way of governing and organising our hospital services and the HSE is committed to ensuring that this transition is managed as effectively, safely and swiftly as possible. The HSE will ensure the greatest degree of support is provided to each of the hospitals within the planned groups to ensure that they can each participate in the development of appropriate shared governance arrangements which will maximise the benefit to the communities that they serve. I look forward to supporting these hospital groups as they become established on an administrative basis on their journey towards full trust status.”