Six new HSE Regional Executive Officers (REOs) are being recruited to head up the six health regions which will begin operations from February 2024, with further reforms and devolution of authority to take place on a phased basis through 2024 and 2025.
Each REO will be the accountable officer at Health Region level, responsible for the delivery of high-quality, safe, and accessible services for the population of their region.
REOs will report directly to the HSE CEO on the operation and management of the Health Regions. They will form part of the core HSE Senior Leadership Team, providing regional input into the development of national policies and standards.
The REOs’ salaries will be linked to the pay under the new public-only hospital consultant contract – up to €257,000.
Existing Hospital Groups and Community Healthcare Organisations (CHOs) are already meeting in regional pods that are reflective of the Health Region structures. The associated interim HSE senior leadership arrangements have also been stood up.
CHO and Hospital Group management teams will support and report to REOs in early 2024 while the Health Region senior executive teams are being appointed. By the end of 2024, existing Hospital Group and CHO structures will be stood down as new Health Region arrangements are embedded.
Each Health Region will have responsibility for the planning and coordinated delivery of joined-up health and social care services within their respective defined geographies as part of an integrated structure.
Cabinet has approved the Health Service Executive (HSE) Health Regions Implementation Plan, which provides for the coordination and delivery of health and social care services along regional lines and aims to facilitate more integrated care for patients and those who use the services across the country. It also aims to enable a coherent population-based approach to service planning and delivery, where care is planned and funded in line with people’s needs at regional and local level.
The HSE Health Regions Implementation Plan clarifies objectives, critical actions, and timelines to progress implementation that have stakeholder buy-in and ownership.
Health Regions will have appropriate autonomy over how their various resources and providers are organised to deliver on the nationally agreed priorities. The Department said they would co-design a framework of nationally consistent standards, guidelines, and governance policies with the HSE Centre. Health Regions would build capability to inform estimates and the annual service planning process and operational plans for their region. They would develop a regional plan in line with national frameworks, need assessments and clinical programmes, with patient outcomes at the forefront. They would embed a culture of continuous improvement to support the delivery of high-quality services.
Health Regions will have appropriate operational budget authority and flexibility. They will operate within a budget informed by the population needs of their region and informed by Governmental priorities and policies. Health Regions will lead on making procurement decisions for their regions within co-developed national frameworks. They will conduct financial planning and analysis to ensure the appropriate utilisation of funds and will manage the financial performance within a region in accordance with national standards and guidelines. As Health Regions develop their approaches to financial and business functions, there will be a focus on ensuring that budgets are managed effectively and in keeping with good governance practices.
In time, a nationally agreed formal mechanism will be put in place to allow patients and service users to transfer seamlessly between services offered in different Health Regions. People in all regions will have access to nationally delivered services based on agreed clinical care pathways.
The nature and role of the HSE Centre will change significantly. The HSE Centre will become “strong, lean, and agile,” becoming less operational and instead having a greater focus on supporting service delivery at the regional level through the co-development of national standards and frameworks, as well as developing national strategies and implementation plans aligned with national policy. The HSE Centre will have a key role in providing national oversight of the regions and health and social care system as a whole, with a primary focus on Planning, Enabling, Performance and Assurance. In addition, it will continue to provide operational delivery of identified specialised services nationally.
The HSE Centre will support Health Regions by ensuring consistent national frameworks and models of care and networked care pathways are co-developed. It will focus on more strategic rather than operational activities, and will devolve responsibility and authority for delivering the vast majority of services to the regions.
Health Regions will collaborate with the HSE Centre to co-design national service requirements and standards, with the HSE Centre enabling and assuring the performance of the health service delivery system as a whole against agreed performance metrics.
The Performance and Accountability Framework of the HSE will be revised to reflect the new governance and organisational arrangements. The HSE Centre will plan, resource, and deliver a small cross-section of services, namely, national services (e.g. National Ambulance Service, National Screening Services, National Environmental Health Service, and the National Office for Suicide Prevention) and national shared services (e.g. PCRS, Statutory Home Support Scheme), which would not be efficient for a single Health Region to deliver. The HSE Centre will proactively seek to avoid unnecessary duplication of national functions in the six Health Regions. The National Ambulance Service will work closely with each Health Region to support patient flow and will have a senior officer available to the REO.
in line with the Government Decision in April 2022, Health Regions will continue to be part of the HSE rather than their own legal entities and as such will not have their own boards. Health Regions will report to the HSE Board via the HSE CEO. The HSE Board retains a governance and oversight role as set out in legislation. Therefore, the primary accountability for corporate governance remains with the HSE Board, sub-committees of the Board, and the HSE CEO. The HSE Board remains accountable to the Minister and DoH for all regional and national service provision in line with strategic priorities.
As part of this work, the current Regional Fora arrangements will be aligned to the Health Regions.
As the six regions each serve large populations in their own right, it is recognised that a sub-structure within each region will be required and must be designed from the ground up. It is currently proposed that these sub-structures will be called Integrated Health Areas (IHAs). They will serve a population of up to 300,000, will take account of varying geographies, population size, local needs, and services.
The existing 96 Community Healthcare Networks (CHNs) and the Community Specialist Teams (CSTs) will act as the building blocks of integrated service delivery, and each Integrated Health Area will be comprised of multiple CHNs / CSTs and will have primary access to at least one hospital.
Integrated Health Areas will also partner with local social services, non-governmental organisations (NGOs), local authorities, and other public bodies involved in broader determinants of health to reach patients and service users impacted by exclusion, disability, and/or poverty. Further detailed design work will consider the alignment of proposed IHAs with national ambulance service areas, and emergency planning areas, as well as how national service providers will fit within the new structures. More work is required to finalise the approach to SLAs given the multiple different scenarios involved.
The Regional Executive Officers will serve as members of the HSE Senior Leadership Team and will report directly to the HSE CEO on the operation and management of the Health Regions. Regional Executive Officers will form part of the core HSE Senior Leadership Team, providing regional input into the development of national policies and standards. It is planned to undertake this reform on a headcount neutral basis with respect to senior level posts, with the exception of posts which have already been provided for in Estimates 2023, e.g. the Regional Executive Officers. This will be important in terms of ensuring efficiency, clear lines of reporting, and a strong lean HSE Centre
The Health Region Oversight Group Chaired by the HSE CEO, will be established to further oversee the successful management and coordination associated with the implementation of Health Regions. The Health Region Oversight Group will review and approve key decisions made by the Health Region Implementation Planning Group, and recommendations and outputs of the Health Region Oversight Group will be reported to and governed by the HSE Board and the Sláintecare Programme Board.
Bernard Gloster, Chief Executive Officer of the HSE and Co-Chair of the Sláintecare Programme Board, said, “These changes aim to ensure that when we give health services to our citizens that we do it in a joined-up way via GPs, community services, nursing support, social care services and acute hospitals as needed. The idea behind reorganising our structures is to ensure that people experience just one health service, providing whatever care they need at the right time and in the right place. When we talk about ‘integrated care’, this is what we mean. In line with the introduction of health regions, I am currently finalising plans for a changed HSE centre and this will add to the overall improvement in governance and leadership of the health service.”
The HSE Health Regions Implementation Plan can be found at: https://www.gov.ie/en/publication/4eda4-slaintecare-regional-health-areas-rhas/#hse-health-regions-implementation-plan