A new way of working

The new leadership changes reform the “centre” to establish a new way of working, which could be characterised as a ‘noses in, fingers out culture’ as between the “commissioning” and service delivery parts of the health service according to HSE Director General, Tony O’Brien. Maureen Browne reports.

The DG said these changes would enhance performance and management across the health services, enable immediate application of recommendations following the review of the Accountability Framework and allow delivery of the health priorities in the Programme for Government.

In the case of CHO Chief Officers to provide them with a single dedicated National Director for Community Health Services who will operationally manage them and hold national accountability for the delivery of services commissioned from the CHOs and for their financial performance.

He said the national corporate structures currently in place predated the creation and establishment of the Hospital Groups and the Community Healthcare Organisations and came into being at a time of change, restructuring and uncertainty. They had served well but now was an opportune time to review them to ensure:

1. They are supporting the delivery of healthcare services in the most effective way possible so that value for patients and taxpayers in its widest sense (quality, safety, effectiveness, efficiency etc) can be delivered and demonstrated in order to assist in securing the most appropriate investment in health and social care over the next 10 – -15 years.
2. They can deliver the health service improvement outlined in government policy including the necessary shift to prevention, promotion, self care and care at the least complex level and location appropriate, consistent with the implementation of the Healthy Ireland strategy for more sustainable models of health, wellbeing and care.
3. There is clear accountability for the management and delivery of services with integrated planning matched by integrated Operations within an overall “silo free” culture.
4. There is a networked organisational culture at national level amongst all those at National Director grade (which includes HG CEOs) throughout the system and CHO Chief Officers, as well as our key clinical leaders in order to foster a silo free culture, irrespective of formal reporting lines.
5. The planning, design and ‘commissioning’ of services is fully informed by the realities and challenges of the operational issues within current models but is not overwhelmed by those and can focus on the necessary medium and long term changes to bring us to a more sustainable service.
6. The operational and performance management of the system is based on improved differentiation and diagnosis of what can realistically be expected from a given quantum of resource inputs taking account of current models of service delivery, wider constraints and the need to make change in a properly structured way over reasonable time periods.
7. The frontline service delivery entities (Hospital Groups, Community Health Care Organisations), National Ambulance Service, Primary Care Reimbursement Service etc) develop optimally to be more directly accountable and responsible for what they do,
8. The core service “divisions” are enabled to focus on their strengths in need assessment planning, prioritising, specifying funding/defunding, monitoring and evaluating the service that they “commission.”
9. In the case of CHO Chief Officers to provide them with a single dedicated National Director for Community Health Services who will operationally manage them and hold national accountability for the delivery of services commissioned from the CHOs and for their financial performance.
10. To maintain (for the foreseeable future at least) direct line management of the Hospital Group CEOs, while also providing for a national “commissioning” type role.
11. A new single focal point for medical leadership throughout health and social care, with a strong mandate for the promotion of service and clinical excellence and so sustain and further develop the crosscutting Clinical Advisory and Group Lead role.
12. To fulfil the Programme for Government commitment regarding the establishment of the Performance Management Unit being initiated by the HSE with the agreement of the Department.

Mr. O’Brien said that until the new appointments were made it was very much business as usual under the existing arrangements. Staff within the existing national “divisions” would be consulted on the best way to manage the transition.

He said all National Directors would commence a process of engagement with Divisional staff to consider what changes might be required in their existing team structures in order to ensure they were aligned appropriately with these three new roles. Each National Director would prepare an evaluation of their structure at national level including a proposal for any changes along with an implementation plan for these changes for his consideration.