Report examining HSE criticises duplication within group

A REPORT examining how the Health Service Executive (HSE) could deliver more integrated care is ritical of the amount of duplication within the organisation.

It also criticises the “distance” between HSE leadership and local providers and it calls for a bigger role for doctors in running the health service.

The McKinsey report, Organising to Deliver Integrated Care, says while the creation of the HSE “was an important step in taking a national perspective to ensure greater focus to patients”, the service needs to evolve more to meet the needs of the Irish population.

The report says the organisation “has a number of layers with potentially overlapping functions and remits”. It says the replacement of the health boards by the HSE has brought many benefits, but also challenges, including “organisational complexity, lack of clarity for accountability in certain areas, some overlap of functions/results”.

“Not only is this duplication, it also slows the ability of the service to implement new models of care.

“Not surprisingly, stakeholders across the service feel that some structural change could bolster the ability of the HSE to deliver integrated care,” McKinsey says. According to McKinsey, many of those interviewed felt the HSE suffers from the fact that previous organisational changes have not been fully implemented at all levels.

It also says there is a strong appetite for genuine service improvement at all levels of the HSE and an eagerness to address problems at a local level.

The report proposes a number of structural changes, including the HSE top team configuration.

It says at the top team level, the HSE should strengthen clinical leadership by appointing a national director of clinical care. The HSE has done this with the appointment of consultant haematologist Dr Barry White, who takes up the post next month. It also recommends the HSE merge the Primary Community and Continuing Care and hospital pillars under a single national director of operations.

This would have meant the suppression of one national director post. Instead of doing that, the HSE has retained both the national director of the national hospitals’ office, Anne Doherty, and the national director of the PCC, Laverne McGuinness and given them new titles as “joint directors for integrated care”.

The report also says that at regional and local level, “administrative structures should be simplified and made as lean as possible” and that “international clinical evidence suggests that six to 10 regions with a catchment population ranging between 500,000 and 700,000 people could deliver high-quality integrated care”. However, the HSE has decided not to change the existing model of four administrative regions.

The report, which has so far cost more than €870,000, recommends the HSE devote 12 to 18 months “of sustained focus” to a detailed organisational change programme it wants to succeed in achieving significant improvements in performance.