Will the Intended Benefits of Regionalisation be Realised?

Restructuring an area as complex as healthcare is seldom a straightforward process. The plan to devolve the Irish health service into six regions was always likely to encounter teething problems. But the scale of the problems that have recently emerged is perhaps a surprise.

Earlier this year, three of the new health regions – Dublin and South East, Dublin Midlands, and the South West – were placed in ‘tier three escalation’ as a result of overspend.

This involved employment controls being imposed on the regions and a greater scrutiny of expenditure. However, these measures have apparently failed to control the issue.

And now The Irish Times has reported that the three health regions, as well as West and North West, are to lose their autonomy over day-to-day spending.

The decision to curb the financial power of the regions in this way goes against one of the reasons they were introduced in the first place.

It should be remembered that the health regions were part of efforts to introduce a more transparent, population-based approach to healthcare funding.

According to the implementation plan, published in 2023, this would “enable Government to make informed decisions in relation to resource allocation and to support health regions to plan and deliver services based on their specific demographic pressures”.

“While this does not change the total quantum of funding provided through the annual Estimates process in any given year, a population-based approach better enables Government to distribute the funding available through the Health Vote equitably and transparently in line with population need,” the document stated.

According to the plan, it would allow for value-for-money assessments to be made that can link population health outcomes and “the productivity of our system to the financial investments made”.

The implementation plan further stated that such an approach to service planning and resource allocation seeks to achieve “allocative efficiency of available Government funds, greater predictability in healthcare expenditure, and more informed evidence-based decision making at the local level”.

Clearly, these benefits have yet to materialise. Whether the limitations placed on the spending power of regions are temporary, or result in permanent changes to their remit, remains to be seen.

The uncertainty brought about by regionalisation doesn’t only relate to finances.

A story in this issue of the Medical Independent reveals regional “variation” in the roll-out of the HSE’s enhanced community care programme was questioned by the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation (DPER).

DPER officials asked about reasons for this variation during a special meeting of the health budget oversight group focusing on primary care services earlier this year.

In response to DPER’s queries, HSE officials told the meeting that the integrated care programme for older persons and the community healthcare networks were “not fully rolled out” in all six regions.

Where rolled out, the officials said that “they are not always implemented in the same way”.

The health regions were intended to make services more equitable, by bringing decision-making closer to local communities. For now, however, these issues with funding and service delivery suggest that the new structures have some way to go before that ambition is realised.

The decision to curb the financial power of the regions in this way goes against one of the reasons they were introduced in the first place