Department of Health and Children

Audit of the Structures and Functions in the Irish Health System

Background

The Audit of the Structures and Functions of the Irish Healthcare System was commissioned by the Department of Health and Children in June 2002 and was conducted between July 2002 and January 2003.

Objectives

The primary objective of the Audit as set out in the terms of reference was:

• to establish the organisational improvements needed to strengthen the capacity of the health system to meet the challenges of implementing the programme of development and reform set out in the Health Strategy document Quality and Fairness: A Health System for You.

The purpose of the project was to determine whether or not the structures in the health system:

• Were the most appropriate and responsive to meet current and future needs
• Constituted an adequate framework for overall governance of the health system
• Achieved an effective integration of services across all parts of the system
• Adequately represented the views of consumers in the planning and delivery of services
• Focused sufficiently upon the principles of equity, accountability, quality and people-centredness and the national goals of the health strategy and to recommend any changes believed to be necessary as a result of the analysis, including an implementation strategy for any changes proposed.

Approach Taken

The starting point for the Audit was a review of all existing state health agencies to critically examine their: number and configuration, interactions with one another and with the Department of Health and Children, adequacy of governance arrangements, and scope for rationalisation.

The list of agencies specified for inclusion in the Audit was extensive, 58 in total, covering statutory and non-statutory bodies, health boards, the Eastern Regional Health Authority and the statute-based hospitals. As the project developed, it was agreed with the Steering Committee that the Audit should consider a future direction for the Irish health system, in order to provide a framework for the future, as well as a context for the changes envisaged.

Prospectus led the Audit and carried out the project in conjunction with Watson Wyatt Worldwide, with the assistance of a liaison team from within the Department of Health and Children and a steering committee, and with the support of an international advisory group consisting of healthcare practitioners and experts from the UK, Canada and Australia.

The Audit of agencies was largely addressed through a literature-based review of the relevant legislation, policy documents and other corporate reports such as annual reports and strategy statements. This approach was specified in the Department of Health and Children's scoping of the project. Each agency was requested to submit relevant material to the Department to facilitate the analysis.

A detailed analysis of agency functions, including overlaps, interdependencies and inter-relationships was carried out.

A second strand of analysis was based on a review of previously published commentary on the health system and Prospectus's experience in the sector. This supported an examination of governance and accountability arrangements.

The Audit did not seek to review the performance of the individual agencies.

Outcomes

The final report proposed four major reforms to the Irish healthcare system:

• The creation of a consolidated healthcare structure
• The development of supporting processes to strengthen the functioning of the consolidated structure
• The strengthening of governance and accountability across the system
• A reorganisation of existing agencies and their functions

Taken together, these reforms were designed to give:

• Structures and functions that support the delivery of national priorities for healthcare and the implementation of Quality and Fairness (health strategy)
• A service which combines the best of service organisation values with public sector responsibilities
• Structures and functions that deliver real value from ongoing investment in healthcare
• A health system that responds more effectively to the expectations of its stakeholders and achieves a much greater impact to the benefit of the consumer
• Structures and functions that help to create a high-performing health system and build on the existing talents and knowledge of staff

All of the main recommendations were agreed by government and are in implementation.