'Significant' investment needed to replace HSE structures with new regional health areas

The RHAs will replace the current system of hospital groups and community healthcare organisations as part of the Sláintecare reforms, the Oireachtas health committee heard on Wednesday. File picture

The way health treatment is set up makes helping patients “an impossible task” and significant investment is needed to replace these structures with regional health areas, the Oireachtas health committee has heard.

The move would see all health services, including the HSE, divided into six geographical areas, known as RHAs.

Each area would have a large population with a budget of multiple billions and tens of thousands of staff. They would offer treatment across primary care, hospitals, mental health and all types of healthcare.

The RHAs will replace the current system of hospital groups and community healthcare organisations as part of the Sláintecare reforms, the Oireachtas health committee heard on Wednesday.

Regional Health Areas Advisory Group chair Leo Kearns told the hearing patients face blockages due to a lack of joined-up thinking, with treatment separated into silos which may or may not communicate with each other.

“Implementing RHAs is an extremely challenging and large-scale change. It is not credible that change of this magnitude can be managed without a significant investment in an implementation support infrastructure,” he said.

Radical changes

The topic may sound dry, he said, but without these radical changes, patients will not see improvements.

“There is a perception that the health service is just the HSE,” he said, when GPs, disability providers and other sectors also need to be connected together.

He urged the committee to commit to change at all levels, with plans for RHAs to interact with local authorities as well.

It is difficult to see much real progress being made on implementation unless senior leaders in HSE and Department of Health are freed up from some of their ‘business as usual’ responsibilities to devote significant thought and time to this,” 

he said.

Social Democrats TD Róisín Shortall asked if there was recognition from hospitals that RHAs would mean a single budget for them and all community services.

“I think people are up for it, but they need to believe this is going to happen,” Mr Kearns said. 

“They need to be involved in designing it, and they need to know we will not deviate from this again.”

He said the RHAs must have clear control models, comprehensive authority and transparency around how they will be held to account.

He told Fine Gael TD Colm Burke it would not just be a matter of putting people into roles, but of having a workforce strategy to make this effective.

Committee members, including Sinn Féin health spokesperson David Cullinane and Senator Frances Black, focused on how this large-scale change could begin, especially around developing new funding models.

Mr Kearns said: “This is not going to happen on a wing and a prayer.” 

Clear leadership was needed in setting out the organisational model first, he said, but he conceded many people who would ordinarily be involved with this are still caught up with tackling the Covid-19 pandemic.

He said HSE centralised funding offices were swamped with the number of business cases they receive currently, and it is expected this will be devolved into the regions.

Munster will include three areas: Cork and Kerry as area D; Limerick, Clare and Tipperary North as area E with Tipperary South and Waterford part of area C.