Previously, I discussed the proposed changes to the Irish Healthcare in terms of Money follows the Patient, and the proposed move to Universal Health Insurance. In order for Healthcare in Ireland to move towards implementation, it first requires putting in place Hospital Groups and setting these groups up as Trusts.
In 2013 the roadmap was set out in the document “Establishment of Hospital Groups as a transition to Independent Hospital Trusts. http://health.gov.ie/blog/publications/the-establishment-of-hospital-groups-as-a-transition-to-independent-hospital-trusts/
In this document, the former Minister of Health, Dr James Reilly laid out the reasoning behind the establishment of Hospital groups.
“The establishment of Hospital Groups and, subsequently, Hospital Trusts, will enable hospitals to provide care in the right way, at the right location. This must be done in a manner that ensures a safe, high quality service for all, maximising and capitalising on the strengths of both larger and smaller hospitals, with best outcomes for patients paramount in every facet of their services.
Groups must manage their own affairs with good transparent governance. Each Hospital Group must operate with maximum autonomy to allow them to innovate and develop optimally, but also including all necessary inter-group co-operation”
The proposal will put the 50 acute hospitals around the country into a six hospital group model, each group is linked to an academic partner. Each grouping will include a primary academic partner which will stimulate a culture of learning and openness to change within the hospital group:
(i) Dublin North East
(ii) Dublin Midlands
(i) Dublin East
(iii) West / North West
(iv) Paediatric – including new Children’s Hospital
The groups proposed are strategically assigned to:
- Align hospitals in geographical areas into groups to meet the acute hospital care requirements of the population.
- Combine varying model, size and specialty hospitals to maximise the range of services available to the population of the geographical area.
- Form single cohesive entities.
- Ensure a population base and infrastructure to maintain the viability of groups.
- Create hospital groups large enough to gain efficiency from common business processes.
- Enable groups to co-operate with each other in an environment of managed competition.
- Attract and retain sustainable numbers of high quality staff members across the full range of healthcare specialties and professions, across all hospitals in a group and across all groups.
- Deliver internationally comparable quality care for patients, regardless of where they live.
It is expected that:
- This will provide an optimum configuration for hospital services to deliver high quality, safe patient care in a cost effective manner.
- Grouping hospitals will allow appropriate integration between hospitals.
- This change will minimise unnecessary duplication in hospital services, and build upon specialist expertise available within the group. Money Follows the Patient (MFTP) will incentivise the rationalisation of services by the hospital groups and encourage the delivery of care at the most efficient point within and between groups.
Governance of Hospital Groups
The main governance recommendations of Hospital groups are around the establishment of interim boards and service plans;
- ·Each hospital group will establish an interim group board to which the Group Management team will report
- The primary function of the interim group board is to oversee the delivery of high quality, safe patient care to meet the needs of the population it is appointed to serve.
- Each hospital group will agree an annual business plan / Memorandum of Understanding(MoU) with the Director General of the Health Service Executive (HSE)/Director of Acute Hospitals. The plan will state the performance and outcome targets to be met within a defined timeframe and what nationally agreed measures will be used in order to monitor performance.
- The interim group board will develop a Quality Improvement Framework to monitor the delivery of high-quality, safe patient care at all levels and on all sites across the group.
- Hospital groups will be required to comply with clearly articulated national performance requirements in relation to issues such as quality, access, and financial management.
- The CEO and Executive Management Team of the hospital group will attend board meetings, but will not be members of the group board.
Hospital groups will adhere to the terms of Business Plan/MoU (for the group) or contracts for the provision of services set out for them. These Business /or contracts must give maximum flexibility to the hospital group whilst ensuring all necessary synergy and linkages required for the overall national health plan to be implemented.
Where a hospital group has one or more pre-existing hospital boards, the hospitals in the group must work, through voluntary delegation of powers and common membership, to reach a position where the interim group board is the effective decision-making body for all hospitals in the group.
Timeframe for Implementation
Movement on the setting up these groups and appointment of key management positions started in 2014.
The move towards Hospital Groups will continue at pace in 2015.
Mark Grant - Business Services Manager, Sláinte Healthcare
Mark joined Sláinte Healthcare in 2011. As Business Services Manager he has responsibility for teams working on Hospital sites, to improve the private health insurance claim revenue cycle for clients in the Irish market. Mark has over 10 years’ experience in project management and commercial roles both in Ireland and the UK and holds a Bachelor of Science degree and an MBA. Mark believes technology can deliver significant process improvements for hospitals.