Minister sets out timetable for reform

Health Minister, Dr. James Reilly, T.D., has set out target times for the implementation of 48 health reforms including free GP care, Hospital Trusts, Universal Health Insurance and the new management structure and reporting relationships for the health services.  Maureen Browne reports.

Free GP cards are to be provided to people with long-term illnesses by the middle of next year, as the first phase of introducing free GP care for all and universal healthcare insurance is to be introduced  from 2016, according to Health Minister, Dr. James Reilly, T.D

This emerged with the publication by the Department of Health of a new document “Future Health: A Strategic Framework for Reform of the Health Service.”  Effectively, this sets target times for the implementation of 48 health reforms, most of which are already part of the Programme for Government and one – the free GP cards for people with long term illnesses –  which had already been promised for next March.

The Minister intends that the HSE will recruit and appoint National Directors for Health & Wellbeing, Hospitals, Primary Care, Mental Health and Social Care, to manage the services.

Pledges included in the strategic framework for reform document include:

• The framework for the reorganisation of hospitals into groups on an administrative basis will be published later this year and Trusts will be established in 2015.  Group Chief Executives will have budgetary and staff responsibility for both HSE and voluntary hospitals in the group. Smaller hospitals will be developed in tandem with the hospital groups.
• The Department of Health will make recommendations by the end of 2012 on the composition of hospital groups, the criteria for the formation of hospitals groups and the first wave of new hospital groups to be established immediately thereafter.
• The Minister will introduce legislation which will give him the power to decide which long term illnesses will qualify for free GP cards.
• The top tier of the HSE management is to be overhauled and advertisements for new posts are expected to be placed shortly.
• In anticipation of the legislative changes, the Minister intends that the HSE will recruit and appoint National Directors for Health & Wellbeing, Hospitals, Primary Care, Mental Health and Social Care, to manage the services.
• The roles of the new National Directors will be different to that held by National Directors in the old management system. The newly appointed heads in these portfolios will be responsible at national level for the delivery of services in the relevant service domain. They will also lead the development of national service strategies associated with their areas. They will monitor performance of their sectors on behalf of the Director General, escalating any issues of persistent poor performance as they arise. They will also be required to work to develop the strategic commissioning frameworks for their areas in accordance with overall policy on financial reform.
• Under the new management structure, the Regional Directors’ role will, over time, change from a direct operations management function to a control and performance management function for finance, access and quality.
• The new structure will see hospital groups reporting to the National Director for Hospitals and the Integrated Service Areas reporting to the National Directors for Primary Care, Mental Health and Social Care as appropriate.
• The Department of Health will work with the HSE to develop Sectoral Plans for Shared Services and External Service Delivery by end of 2012.
• The Department of Health, in conjunction with the HSE, will conduct a review in 2013 of corporate functions and resources (staff and budget) of the various corporate/support/shared services as they currently exist within the HSE and make recommendations for the future.
• The control of health spending will be returned from the HSE to the Department of Health in 2014 and new financial management systems aimed at controlling costs will be introduced.
• The Department of Health will establish an appropriately resourced Programme Management Office in 2013 to drive, co-ordinate and monitor the reform programme.
• The Department will develop a proactive Consultation, Collaboration and Communication plan for the reform programme in 2013.
• The Department of Health and the HSE will continue to use the Public Service Agreement to the fullest extent possible between 2012 and 2014 to protect health services and to facilitate implementation of the reform programme.
• The Department of Health will work with the HSE and relevant experts to develop a series of leadership and learning sets in relation to governance, quality and safety of health care delivery, to meet the requirements set out in the HIQA report on Tallaght Hospital.
• The Department of Health, with the HSE, will further develop an approach to address both short-term and long-term succession requirements at senior management level from 2012.
• A new Patient Safety Agency, which will build on the existing functions of the Quality and Safety Directorate of the HSE, will be established on an administrative basis in 2013
• HIQA Inspections will be extended to residential centres for people with disabilities in 2013.
• BreastCheck cancer screening will begin to be extended to women aged between 65 and 69 in 2014.
• The new Child & Family Support Agency will be established.
• A Health and Wellbeing Agency will be established in 2015.
• The Department of Health will develop time-bound plans for the implementation of Money Follows the Patient by end 2012.
• The first round of the colorectal cancer screening programme for men/women in the 60 – 69 age group will have been completed by the end of 2015.
• The Roll out of programmes for chronic disease will begin with diabetes care ahead of the roll out of programmes for cardiac, respiratory and neurological conditions between 2013 and 2015.
• Proposals will be published for reform of payments and service delivery systems that will support real integrated care for patients.
• A White Paper on Universal Health Insurance will be published in 2013 and a preliminary document in 2012.
• There will be a review of Integrated Service areas to ensure maximum alignment between all service providers, at local level, review executive management and governance arrangements and inform new systems for the delivery of primary care
• The Minister says he wants to see money following the patient, with payments made per medical procedure rather than based on the number of nights a patient spends in hospital.
• New charges for certain social and continuing care services for older people and the disabled will be introduced in 2015 and the Department is to develop policy in relation to these charges.
• The Department of Health will work with the HSE and the State Claims Agency to develop a risk based approach to provision of indemnity to services and professionals by end 2013.
• The Department of Health will establish a National Task Force on Prescribing and Dispensing Practice by end of 2012.
• The Department of Health will work with the HSE to ensure the delivery of the targets for routine and urgent endoscopy procedures by end of 2012.

The next phase of structural reform will involve the creation of a formal purchaser/provider split within the health sector though the system will remain entirely tax funded during this phase. The directorate management teams involved in performance, contracting and financing of services will be subsumed into a new commissioning body the Healthcare Commissioning Agency in 2014, where they will be charged with continuing to drive performance improvement through value-based purchasing. At this point, the HSE will effectively be dissolved. There will be consultation with staff interests on all relevant issues which may arise in this context.

The Department of Health will work with the HSE and relevant experts to develop a series of leadership and learning sets in relation to governance, quality and safety of health care delivery.

The Healthcare Commissioning Agency will encompass the funds previously managed by the HSE directorates. It will be subject to the instructions of the Department of Health and will transform national policy priorities and service targets set out by the Minister for Health into detailed performance contracts with healthcare providers. It will then manage all payments to providers. Performance contracts will explicitly link payment with the achievement of targets across the spectrum of quality, access and activity. Hospitals will evolve from groups to trusts.

The final phase of structural reform will see the move to a combination of universal health insurance funding for acute hospital and certain primary care services, with general taxation funding for other services including the social care services such as disability and long-term care.

The Healthcare Commissioning Agency established in phase two will divest some of its purchasing functions to health insurers under UHI, but will still play a central role within the health system. Within the Agency, the transitional primary and hospital care funds will transform into a health insurance fund.

The Healthcare Commissioning Agency will also continue to finance certain health and social care costs directly via the other funds. As such, it will retain a central strategic role in terms of managing the flow of funds between different arms of the health system and in working with health insurers to support the delivery of high quality, integrated care.

The Department of Health will pursue cost control in the private health insurance market in particular through the Consultative Forum on Health Insurance and through the external review in 2012 of the VHI’s claims costs. Implementation of these initiatives will continue through 2013 and beyond.

The Department of Health will introduce a permanent scheme of risk equalisation to support the principle of community rating from 2013.

The Department of Health will address the regulatory status of the VHI, in line with the European Court of Justice ruling, by no later than the end of 2013.

The Department of Health will work with the HSE to increase the numbers of health care professionals working in primary care from 2013.

The Department of Health will support the HSE to roll out a single assessment tool for older people services in 2013.

The Department of Health will commence work on a national standard assessment tool for people with disabilities as part of a resource allocation framework in 2013.

The Department of Health will extend the HIQA regulatory regime to residential services for people with disabilities in 2013 and to other social and continuing care settings by 2016.

The Department of Health will commence a review of the Fair Deal scheme to assess its sustainability by 2012 and will further review the scheme to assess its applicability to other sectors such as the disability and mental health residential sectors by  2013.

The Department of Health will work with the HSE to complete a prospective funding model for palliative care in 2013.

The Department of Health will develop an eHealth Strategy in conjunction with the HSE by 2013. This will serve as a blueprint for the design and implementation of eHealth systems to support and enable the delivery of integrated patient care under the reform agenda.  The Department of Health will ensure that the necessary preparatory work is undertaken to allow publication of the Health Information Bill by 2013.