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Regionalisation plan ‘lacks meaningful devolution of authority’

By David Lynch - 08th Oct 2023

Regionalisation plan

The IHCA President has questioned how effective the HSE’s plan for six new health regions will prove.

Speaking to the Medical Independent, Prof Robert Landers said that “it makes sense on the level of aligning hospital and community services into six coherent organisations”.

“But what we are not seeing with the health regions is a plan to devolve authority down to the individual local level,” he said. “And our concern is that this is just another layer of administration within the health service that removes decision-making away from the frontline to a higher level and will impact and hinder efficient and quick decision-making.”

Prof Landers said he would like to see “the devolution of authority down to individual hospitals”. He added this should reach down to hospital managers and clinical directors “who are on the ground and best placed to make those decisions”.   

During his address to the IHCA Annual Conference, Prof Landers told attendees that a “centralised system” like the HSE does not work. He said a new system “will only work if it devolves authority down”.

“We saw that to very good effect during the pandemic, the shackles were taken off, hospital managers were allowed manage their resources and despite having inadequate facilities, like the lack of ICU beds, the hospitals coped tremendously well during the pandemic,” he said.

“It did show that if you take the decision from Dr Steevens’ Hospital [HSE headquarters] that the system can flex, it can respond and react.”

However, he said that the path being taken in the creation of the new health regions was “worrying”.

“It leads me to ask the question are we just shuffling the deck chairs around the Titanic…. Will power still be centralised? Will every decision come back to the central hub to be made?”

Sinn Féin Leader Mary Lou McDonald, who was also speaking at the conference, agreed with Prof Landers’ concerns regarding the new health regions.

“The big challenge, from a public administration point of view, is that clawback [of power back to the HSE centre] will happen. So, we will have to be very vigilant that we get proper devolution for capital acquisition, investment, recruitment, retention, all of that. All of that is much better if it’s at a regional level.”

Separately, Prof Landers told delegates that the external review into spinal surgeries at  Temple Street Children’s Hospital needed to be systemic in nature. He said “scoliosis patients and their families who, for decades, have had to battle the system, find themselves having to do so again”.

“The battle many have to go through in healthcare is real. For hospital consultants, it’s a battle for theatre time, facilities, and basic equipment. A battle with antiquated systems. A battle against the impacts of later patient presentations leading to increased complexity and often a battle to be heard.

“It is fundamental that this review is systemic in nature, because what it concludes and ultimately recommends will influence how all hospitals approach complex surgeries, innovation, risk evaluation, and resourcing into the future.”

Deputy McDonald and Labour Party Leader, Deputy Ivana Bacik, who also spoke at the conference, echoed Prof Landers’ call for a systemic external review.

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