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The regional future of the health service

By David Lynch - 18th Feb 2024

regional future

The HSE will undergo a radical reorganisation from next month with the implementation of the six health regions. David Lynch reports

Addressing healthcare staff in late January, HSE Chief Executive Officer Mr Bernard Gloster said the imminent move to six new health regions “represents a considerable change to our organisational structures”. 

Mr Bernard Gloster

However, Mr Gloster added “structural change is not the main goal” of the reform.

“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.”

The six regional executive officers (REOs) have been appointed and the regions will go live on a gradual basis, beginning next month (see panel).

Mr Damien McCallion

Speaking at the 20th National Health Summit held in Croke Park, Dublin on 7 February, HSE Chief Operations Officer Mr Damien McCallion said the regions were about “trying to push back out and devolve” responsibility across the country. He recognised that the HSE “is often criticised for being overly centralised”.

Reflecting on the old health board system, Mr McCallion said those boards “were probably completely devolved, but didn’t have some of that glue that was needed around policies and strategies so that you could get consistency across the country”.

The new regions, which will commence on 1 March, will be “gradually introduced” until September, he outlined.


The reorganisation will be felt across the entire healthcare system and all specialties. 

Consultant Oncologist Dr Grainne O’Kane addressed last month’s National Health Summit on the issue of cancer care (see p8).

Dr Grainne O’Kane

Dr O’Kane, who is Director of the Cancer Clinical Trials Unit, Trinity St James’s Cancer Institute, later spoke to the Medical Independent (MI) about the structural changes.

“I’m worried that the new regional health areas could further fragment the system, to be honest,” Dr O’Kane said. “I worry about the governance; I worry about leadership. The point I would make is that I want people in the hospitals knowing what’s going on…. I do not want the regional health authorities with leaders sitting in offices and not being ‘on the ground’.” She warned that such a scenario could negatively impact the delivery of care in this country.

Dr O’Kane said that greater digital transformation in healthcare was needed to allow better patient information flow across regions and hospitals and between hospital consultants and GPs.

“There should be no reason why we don’t have an integrated electronic healthcare system in this country,” she told MI. “I know from many GP colleagues, that they do not understand what is happening with their patients [in hospitals]. They are not getting the letter, sometimes they never get letters… then they are trying to figure it out by talking to people themselves.”

Similar concerns have been voiced by other hospital consultants. Last October, IHCA President Prof Robert Landers told MI it made sense to align hospital and community services “into six coherent organisations”.

However, Prof Landers added that the regionalisation plan did not devolve authority at a local level to a sufficient degree.

“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.”

I’m worried that the new regional health areas could further fragment the system, to be honest


Emergency departments (EDs) across the country will be impacted by the new regionalisation programme. The Irish Association for Emergency Medicine (IAEM) President Prof Conor Deasy said the regions could have a positive impact if they help eliminate delayed transfers of care by providing a more “seamless flow of patients” from acute hospitals to community services, rehabilitation facilities, and nursing homes. He told MI that this would create additional bed capacity in hospitals.

 “We should not expect, however, that bed capacity issues will be solved without building beds, be they acute hospital beds in the form of ICU and single room ward beds, rehabilitation beds, and long-term care beds.”

Prof Conor Deasy

 Prof Deasy, Professor of Emergency Medicine at University College Cork and Clinical Director of Emergency and Acute Care at Cork University Hospital, said “there is simply no avoiding this and we should get on and do it; our population need and deserve this.”

Prof Deasy added that regions are seen as an enabler to shift healthcare provision to the community setting. Therefore, providing primary care with “the tools and incentives to deliver unscheduled care would reduce the ever-increasing volumes of patients” who attend EDs.

“It is very important that the required monitoring systems are in place to measure the impact of this investment.” 

According to Prof Deasy, a “key selling point” of the regions “is less bureaucracy and greater agility”.

“…. What works in Cork may not be relevant in Dublin so local fixes and solutions can be more easily facilitated and funded through more localised governance structures delegated to the regions…. This potentially could be a more empowering and rewarding system to be part of,” according to the IAEM President.


GPs will be keenly observing how the new structures will alter the relationship between the primary and acute sectors.

It is “too early to say” what effect the regional structure will have on general practice, Prof Tom O’Dowd, GP and Professor of Public Health and Primary Care, Trinity College Dublin, told MI.

Prof Tom O’Dowd

“It’s a funny thing to say, but it depends what you believe is more important – anatomy or physiology. The anatomy refers to the structure of things and the physiology is the interactions. What I find most beneficial are the interactions with the people in the HSE who I know myself and have solved problems for me in the past, that has worked very well.

“And I would not like to see so much organisation going on that it interfered with those relationships – that the anatomy interfered with the physiology, so to speak.”

Prof O’Dowd was speaking to this newspaper at the Health Summit.

“It does seem that in many ways that we are going back to the older system, going back to having health boards, or at least a version of the health board system. Which actually was quite good a system and was a responsive system generally,” added Prof O’Dowd. “In general practice, I suppose, we tend to take less interest in the structure of the system. And that perhaps is a problem for us; we perhaps need to be more active in it.”   


Also speaking to MI at the conference, former Deputy Chief Medical Officer at the Department of Health, Dr Ronan Glynn, said there will always be “challenges with transformational change”.

Dr Glynn, who is now Partner and Health Sector Lead at EY Ireland, said he believed the health regions will reframe the perception of health service provision.

He added that this reframing should lead to people seeing healthcare as “a continuum across community and acute settings”.

“Then maybe to re-imagine the concept of clinical teams and multidisciplinary work so that teams aren’t just working within the traditional four walls of a hospital, or in the traditional community setting, but instead we have better collaborations across different settings,” he told MI

Regarding the new regions, he said: “I think you have to be optimistic.”  

Dr Glynn’s former public health colleagues within the HSE also envision possible opportunities in the coming changes.

A spokesperson for the Irish Society of Specialists in Public Health Medicine (ISSPHM) told MI that the area directors of public health will sit on the area senior management teams as the regions form.

“This presents an opportunity to influence the agenda, bringing the public health focus and dimension to the protection and promotion of health, prevention of disease, and healthcare delivery,” said the spokesperson.

“Working within the new areas can allow for population-based planning and a real focus on equity and the needs of the regional population and health services.” 


However, the ISSPHM spokesperson warned that this optimistic scenario is not “a given”. 

“There is also the risk that the population focus will be sidelined, with a continued prioritisation of a hospital-centric approach, with acute hospital services receiving the majority of funding and focus,” the spokesperson said.

They added that senior public health leadership is also crucial at national level and that the National Director of Public Health should sit on the executive management team of the HSE. “This is currently not the case.”

The Society believes the new regions “must put a greater focus and investment” into prevention and community resources and developing community-based models of care “rather than just moving acute services into the community to reduce the burden on hospitals”.

The ISSPHM spokesperson added prevention is not merely about promoting changes in risk behaviours, but also ensuring that the broader social determinants of health are addressed.

“Therefore, the new health regions must work hand-in-hand with local county councils, schools, and communities, etc, to ensure that these social determinants are optimised for their regional populations.”

The spokesperson said significant progress in the national digital infrastructure was also needed.

“A unique health identifier, a public health case management system, an immunisation information system, etc, are all critical in ensuring a more coordinated and efficient public health service delivery at a regional level and would also ensure better data to evaluate and improve the services we deliver.”

The nuts and bolts of a new system

On 25 January, the HSE CEO Mr Bernard Gloster announced details of the appointment of regional executive officers (REOs) to lead the six health regions.

Each REO will be the accountable officer at health region level, according to the HSE. They will be “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.

Mr Gloster announced the following as the REO appointments: Ms Sara Long for HSE Dublin and North East; Ms Martina Queally for HSE Dublin and South East; Ms Kate Killeen White for HSE Dublin and Midlands; Mr Tony Canavan for HSE West and North West; Dr Andy Phillips for HSE South West; and Ms Sandra Broderick, who was already in post in HSE Mid West.

The Medical Independent (MI) asked the HSE a series of questions about what can be expected from the new structures.

Q. Does the HSE expect there to be any significant staff movement from HQ at St Steevens’ Hospital to the new health regions?

A. The HSE spokesperson said that Health Regions Implementation Plan (adopted by Government in July 2023) sets out a vision of health regions that “will have the autonomy for both planning and delivery of services” for the agreed population supported “by a lean strong HSE centre that will have a focus on planning, enabling, performance, and assurance”.

The spokesperson added that as the regions are established it is “envisaged that there will be transition of staff from the HSE centre to the new health regions”.

“It should be noted, however, that HSE centre staff, while operating on a national basis, are geographically located across the country.”

Q. Have official names for each of the six health regions been decided?

A. The Executive told MI that “following an initial consultation process”, the following names were agreed: HSE Dublin and North East; HSE Dublin and Midlands; HSE Dublin and South East; HSE South West; HSE Mid West; and HSE West and North West.

Q. Will the REOs sit on national HSE boards/committees?

A. “REOs will sit on the HSE senior leadership team at national level and with the HSE CEO will form the core operational leadership team of the HSE,” said the spokesperson. “The CEO has recently issued a revised HSE centre structure that will primarily support the health regions.”

Q. Is it expected that the REOs will appoint the members to their own leadership team for each of the regions? Will each region be required to have the same leadership team structure?

A. The HSE said that the regional structure of the health region executive management teams “is nearing final completion”. 

“This sets out a standardised approach across all health regions. Staff appointment and transition arrangements are subject to final agreement of the structure and engagement with staff representatives over the coming weeks.”

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