Sweeping changes in the HSE leadership structure include the appointment of four new national directors, it has emerged.
HSE director general Tony O’Brien wants to focus on devolving decision-making and accountability as close as possible to the front-line.
The four new national directors are a chief operations officer, a chief strategy and planning officer, a national director of community health service operations, and a national medical director. In a confidential memorandum seen by the Irish Examiner, Mr O’Brien wrote that the “adjustments” he proposed to the health services’ leadership team had been approved unanimously by the HSE directorate.
“These adjustments are designed to streamline performance and management across the health service with a particular focus on enhancing the integration of services,” he said.
Mr O’Brien explained that the chief operations officer would be responsible for the overall operational performance management of the system, would support the director general and deputise for him as required.
He pointed out that the roles of chief operations officer and chief strategy and planning officer would be filled by the Public Appointments Commission through open completion as soon as practicable. An existing national director will be appointed the national director of community health service, and the operations role of the current national directors for primary care, mental health, social care and health and wellbeing will be subsumed into this role.
The current posts of national director of clinical strategy and programmes and national director for quality improvement will be subsumed into the role of national medical director to be filled by open competition.
Mr O’Brien said clinical programmes and “discreet” clinically led initiatives, such as the new Maternity and Infant programme and the National Cancer Control Programme would be “nested” with the new medical director.
He wrote that it was now three years since the establishment of the HSE Directorate, and while progress on some “key objectives” had been slower than expected, much had been achieved.
“We have seen the development of an external consensus on the need for a longer-term health strategy at a political level and secured an unprecedented mid-year budget revision this year, ending the underfunding deficit spiral of the past,” he said.
“Overall, we collectively lead a health system that is more productive than in the past, but also experiencing unprecedented demand and unmet need.”
Mr O’Brien said the new structures would ensure there was “clear accountability” for the management and delivery of services. The changes would reform the “centre” to establish a new way of working. “This could be characterised as a ‘noses in, fingers out culture’, as between the commissioning and service parts of the health service,” he wrote.
“Until these appointments are made it is very much business as usual under the existing arrangements,” he said. “Staff within the existing national divisions will be consulted on the best way to manage the transition.”
Mr O’Brien ended by stressing that there were may great things about the Irish health service. “We are blessed with our staff and their commitment. These changes are intended to assist the health service to function better.”
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