Micheál Martin T.D., Minister for Health and Children at launch of The Health Service Reform Programme

The Health Service Reform Programme

These are historic times for the health system in Ireland. Yesterday, the Government made decisions which represent the most radical programme of change for the health sector since the establishment of the health board structure in 1970.

The sole objective of our health policy is to deliver access for all to high quality services for patients. The facts show that services have expanded significantly and today there are more people receiving care and support services than at any time in our history. Activity has increased every area of services and there have been substantial improvements in cancer and cardiovascular services for patients and a reduction in waiting times for many specialties.

These are tangible improvements for which the health service gets little credit. But, I agree, the challenge is to go still further and deliver a system which meets the demands of an expanding and ageing population while also adapting to the rapid pace of development in new treatments. In the National Health Strategy we brought together a wide programme of service evaluations and research and set out, for the first time ever, detailed objectives for every element of the health system.

At the time we published the Strategy we said that structural reform would have to follow – that the system should be structured to meet these service objectives rather than trying to fit service objectives into the structures already in place.

The two reports which are being published today involved a comprehensive evaluation of structures, controls and accountability within the system. I would like to thank all those involved in preparing both reports for their work. In relation to the Commission, I would like to join with my colleague, Minister McCreevy in thanking Professor Brennan and the other members of the Commission and in relation to the Audit of Structures and Functions, I would like to thank Prospectus Strategy Consultants and their partners Watson Wyatt Worldwide. I would especially like to thank the officials of both my Department and the Department of Finance who worked closely as a team on many of the issues.

It is interesting to note the reports have, independently of each other, reached similar conclusions about the system and have made comparable recommendations. Essentially, what the reports do is move us from the diagnostic stage to the treatment plan for the system. The intervention proposed is radical. It´s challenging. So why do it? The rationale for change of this order is actually quite simple. The current system was designed in different times to meet different demands. After all, the health structures are over 30 years old and have been expanding since then. Successive Governments have set up specialist agencies -often to give focus and to protect particular policy developments. There are now 58 agencies operating in the public health system. This is not sustainable. This multiplicity has resulted in a complex and fragmented system which has itself become an obstacle to achieving improvements.

Rationalisation, standardisation and much improved co-ordination are all required to overcome this fragmentation and to give me, as Minister a realistic span of control over the agencies for which I am responsible.

A second issue which has arisen in successive reports is the lack of clarity about roles between the Department and the system; and also the tensions between local representation and decision making vis-à-vis national policy objectives. In a system as complex and as broad in scope, it is obvious that clarity about roles, accountability and “where the buck stops” must be completely clear.

A third set of issues relate to how things get done within the system. The central importance of adequate planning processes have been highlighted again and again. Keeping people at the centre of care means that you must start with needs assessment and link planning of services to funding and activity.

Part solutions to these problems in the past have brought us some way forward but part-solutions, by their nature are limited. It is high time to devise a comprehensive and integrated solution for the whole system.


The core of the recommendations involve the development of a new national management structure and the introduction of new financial accountability procedures.

The Government has taken these reports on board and agrees with their analysis of current problems. The reform programme we are launching today sets out the priority actions which we will undertake and the framework within which we will seek to develop the Irish health system.

Reform Programme

The principles underlying the reforms are:

  • A new national focus on service delivery and executive management of the system
  • A major reduction in fragmentation within the system
  • Clear accountability throughout the system
  • Improved budgetary and service planning

And, most importantly, improved patient care.

There will be a major rationalisation of existing health service agencies – with over 32 to be amalgamated or abolished. This includes the abolition of the existing health board structures.

A Health Services Executive will be established as the first ever body charged with managing the Irish health service as a single national entity. The Executive will have its own Board and Chief Executive Officer. The Board will report directly to the Minister for Health and Children. Within the Executive itself there will be three core pillars:

  1. A Primary, Community and Continuing Care Directorate
  2. A National Hospitals Office and
  3. A National Shared Services Centre

It should be appreciated that services will continue to be delivered through the existing hospital and local office network -but they will operate within a fundamentally realigned national management structure.

The Department of Health and Children itself will be completely reorganised to ensure an improved focus on policy development and oversight. There will be a clear separation between the executive and non-executive functions of the Department. Key to its role will be holding the Health Services Executive to account for its performance.

In a moment, the Secretary General will outline the details in relation to the new structures as well as to elaborate on changes in system processes which will be required to support the overall reform agenda.

The proposals emerging will also support the commitments made in the Health Strategy in relation to the reform of Acute Hospital Services. It will provide a more unitary approach to the delivery of hospital services which in turn will support the more even and consistent introduction of consultant delivered services in Ireland.

I want to draw your attention to this issue because it is another strand of reform which will be put to Government shortly -the Report of the Taskforce on Medical Staffing (Hanly Report). The principles which are emerging, are centred on high quality and optimal outcome. International evidence demonstrates again and again that clinical outcomes for patients are improved when they are treated by multi-disciplinary specialist teams operating in units where there are high volumes of activity and access to diagnostic and treatment facilities. But it is neither practicable or realistic to suggest we can provide this within immediate reach of everyone´s home.

It´s time we faced up to these issues. As a society, we need to achieve a consensus about the reality of achieving high quality safe care in a country of this size and population.

This reform programme threatens no one – but it represents a major opportunity for everyone who shares the objective of building an Irish health system which provides high quality care for all.


There is a significant challenge in taking on change of this order. Obviously it’s a personal challenge for me and my Department. But it is also a challenge for the system and the people working in it . We need to be creating an atmosphere conducive to change. More balance and perspective in how we view the whole health system is somewhat overdue. We´re treating more people than ever, quality is improving and productivity is increasing in a range of areas. That´s a credit to the people working in the system and it needs to be recognised.

Most importantly I think we all have to recognise, that with the plans there are challenges for society more generally.

This programme is about providing a framework for developing services and maximising the impact of these services on the patient and clients who rely on them.

We are determined to move forward as quickly as possible with implementation. I hope that we can have a constructive dialogue with all stakeholders in moving forward. I, and my Department will certainly do everything we can to make sure that this happens.

We have already published the Health Strategy which sets out, area by area, the objective of having a system where everyone has access to high-quality care when they need it. It is clear that we have to modernise our structures to meet this objective and that is what we are doing in the health reform programme