The HSE was broken up into six regions two years ago to deliver better care. Is it working?

A decision to halt a national initiative aimed at reducing hospital waiting lists has sparked alarm within Ireland's Health Service Executive (HSE), with the head of the West and North West region warning of "significant risk of unintended harm to patients." Tony Canavan reported that ending the 'insourcing' program, which utilized private companies to leverage HSE facilities and staff, has jeopardized progress and could lead to increased waiting lists and delays in care.

Despite the region presenting several options to mitigate these risks, the national HSE office rejected requests for special exceptions, causing considerable frustration among senior management across the HSE's six newly established regional structures. This disagreement highlights the complex management dynamics that have emerged since the HSE's overhaul in 2024, intended to decentralize operations and improve tailored patient care.

The reform's objective was to integrate hospital and community services under six regional areas, a key component of the Sláintecare plan to create a universal health system based on need rather than ability to pay. Previously, the system operated under a more centralized model with multiple community healthcare organizations and hospital groups.

However, the implementation has faced hurdles. Concerns about the "patchy" operation of the six regions were raised by the HSE board in April, following a deterioration in the service's financial position. To control spending, regions were instructed to reduce reliance on external agencies and convert contract workers to permanent staff. This directive, coupled with the halt of the insourcing initiative, has created a challenging environment for regional management seeking to deliver on the promise of improved, integrated healthcare.

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significant risk of unintended harm to patients