HSE move to tighten budgets

THE Health Service Executive (HSE) is to appoint four regional directors on a one-year-contract, who each face losing control of their budget to central management if they fail to meet targets.

To date, responsibility in the health service has been spread between a number of executives with no one person accountable for all services in the region.

Yesterday the HSE’s national director of Primary, Community and Continuing Care (PCCC), Laverne McGuinness, admitted this arrangement had not been in the best interest of patients and clients.

“It held us back in being able to respond swiftly to their changing needs. This new approach will take decision making and accountability closer to patients and clients,” Ms McGuinness said.

Fine Gael health spokesperson, Dr James Reilly, said he would “like to believe” that by devolving control locally and making a single person responsible the delivery of services would improve, but he wasn’t hopeful.

“If you look at the level of accountability in both Government and the HSE – take PPARS for example, not a single person lost their job over that – then you begin to see a lot of what they say is rhetoric, certainly from my point of view,” Dr O’Reilly said.

Details of the new contracts were outlined yesterday by Ms McGuinness at the Transforming Public Services Conference in Croke Park.

The four regional directors of operations will be ultimately responsible for delivery of all health and social care services in each of the four regions.

“They [the contracts] will be binding and if regional teams fail to meet their targets they could have some elements of their financial authority withdrawn,” Ms McGuinness said.

The contracts will include targets in areas such as finance, human resources, value for money and cost management, service improvements and clinical quality, safety and efficiency.

Ms McGuinness said performances will be reviewed monthly and where there is a risk targets may be missed, the HSE will apply a ‘ladder of support’, beginning with input from teams across the organisation.

“If the corrective measures do not address the risks, a range of additional measures may be introduced which could involve reducing expenditure limits, central management of a region’s budget or ultimately the removal of financial authority in certain areas for a defined period,” Ms McGuinness said.

The process of appointing four regional directors under open competition is ongoing. Separately, the process to merge the HSE’s two main service directorates, the National Hospital Office (NHO) and PCCC into a single Integrated Services Directorate begins next month. The move is central to the HSE’s strategy to integrate hospital and community services at national and local level.