7.2 Administration and governance
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Main actors involved in policymaking
The Department of Health's mission is to improve the health and wellbeing of people in Ireland by delivering high quality health services and getting best value from health system resources. The Minister for Health has overall constitutional and political responsibility for the Department. The Department's main role is to support the Minister and Ministers of State in the development and implementation of policy for the health services. There are 3 Ministers of State assigned to the Department with responsibility for:
- Health promotion and the National Drugs Strategy
- Mental health and older people.
The department also monitors the performance of health services.
Health services are delivered by the Health Service Executive (HSE). The HSE was created by the Health Act, 2004.
The Chief Medical Officer advises the Minister, Minister of State, and the Department on medical issues. The Chief Medical Officer also has responsibility for patient safety and quality, clinical effectiveness, health protection and promotion, tobacco control policy, health and wellbeing, social inclusion, and bioethics.
The Department of Children, Equality, Disability, Integration and Youths’ mission is to lead the effort to improve outcomes for children and young people in Ireland. Among its high-level goals is to collaborate with stakeholders, including across Government, in monitoring and promoting the physical, emotional, and economic well-being of children and young people and reducing inequalities.
The Services Industrial Professional and Technical Union (SIPTU) Health Division represents over 50,000 workers in hospitals, other healthcare facilities and within communities throughout the island of Ireland. Its members are organised in both the public and private sector. There are six Sectors within the Division:
- Nursing and Midwifery Sector
- Allied Health Professionals Sector
- Ambulance Sector
- Support Grades Sector
- Intellectual Disability Sector
- Care Sector.
General distribution of responsibilities between top-level and regional/local authorities
The HSE was established in January 2005 as the single body responsible for meeting Ireland’s health and social care needs. As of 2019, the HSE’s services are organised through six administrative areas:
- North Dublin, Meath, Louth, Cavan and Monaghan
- Longford, Westmeath, Offaly, Laois, Kildare and parts of Dublin and Wicklow
- Tipperary South, Waterford, Kilkenny, Carlow, Wexford, Wicklow and part of South Dublin
- Kerry and Cork
- Limerick, Tipperary and Clare
- Donegal, Sligo, Leitrim, Roscommon, Mayo and Galway.
Each of the HSE Areas has a Regional Health Forum, composed of representatives from the relevant city and county councils. Each Regional Health Forum makes representations to the HSE on the range and operation of health and personal social services in their area.
There are also Regional Health Offices, each led by a Director. Their functions include:
- Supporting the Regional Health Forums
- Facilitating work at an area level, including managing the interface with the Parliament (Oireachtas) members
- Undertaking specific projects on behalf of the Office of the CEO.
The Local Health Office is often the first port of call for the public to access community services. There are 32 Local Health Offices in Ireland, each with a Local Health Manager. Each Local Health Manager works closely with the hospital managers in their geographic area to ensure that patient/client needs are met. The wide range of services that are provided through Local Health Offices and from Health Centres include general practitioner services, public health nursing, child health services, community welfare, chiropody, ophthalmic, speech therapy, social work, addiction counselling and treatment, physiotherapy, occupational therapy, psychiatric services and home help.
Sláintecare is the ten-year programme to transform Ireland’s health and social care services. The Parliament (Oireachtas) Committee on the Future of Healthcare was established to devise cross-party agreement on a single, long-term vision for health and social care and the direction of health policy in Ireland. The committee produced the Sláintecare Report, which was adopted by the government and published in May 2017. The Sláintecare vision is to achieve a universal single-tier health and social care system where everyone has equal access to services based on need, and not ability to pay. Over time, everyone will be entitled to a comprehensive range of primary, acute and social care services. In response to the Sláintecare Report, the government approved the Sláintecare Implementation Strategy on 17 July 2018. It sets out the actions to be taken in the first three years of the Sláintecare implementation process. The Sláintecare Programme Implementation Office was established in September 2018 with the initial task of reviewing and refining the strategy into a more detailed Sláintecare Action Plan for 2019 (Government of Ireland, 2019).
In 2021 there was a new Sláintecare Implementation Strategy and Action Plan 2021-2023 established. This plan sets out the priorities and actions for the next phase of the reform programme in light of Covid-19. The aim of this Strategy is to deliver a universal health service that offers the right care, in the right place, at the right time, at low or no cost.
The Reform Programmes are:
Reform Programme 1: Improving Safe, Timely Access to Care and Promoting Health & Wellbeing
Reform Programme 2: Addressing Health Inequalities- towards Universal Healthcare
Healthy Ireland is a government-led initiative aimed at improving the health and wellbeing of everyone living in Ireland. A Framework for Improved Health and Wellbeing 2019-2025 supports Government’s response to Ireland's changing health and wellbeing profile. It has four main goals, to:
- increase the proportion of people who are healthy at all stages of life
- reduce health inequalities
- protect the public from threats to health and wellbeing
- create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.
It has targeted actions grouped under six broad themes:
- Governance and Policy
- Partnerships and Cross-Sectoral Work
- Empowering People and Communities
- Health and Health Reform
- Research and Evidence
- Monitoring, Reporting and Evaluation
- National Youth Health Programme.
The National Youth Health Programme (NYHP) is a partnership between the National Youth Council of Ireland (NYCI), the HSE and the Department of Children, Equality, Disability, Integration and Youth. Its aim is to provide a broad-based, flexible health promotion/health education support and training service to youth and community organisations and to all those working with young people. This work is achieved through the development of programmes and interventions specifically for and with youth and community organisations throughout the country along with the training and support of workers and volunteers involved in addressing health issues with young people. The NYHP is dedicated to developing and promoting a culture within the youth sector which focuses on health and wellbeing by building the capacity of youth workers and volunteers. NYHP also acts as a conduit between grass roots experience and the development of public policy and national strategy in youth health and wellbeing. The NYCI’s strategy is set out in The National Health Promotion Strategy – Statement of Strategy 2018-2022. NYCI is funded by the Irish exchequer, the European Commission, the HSE, Science Foundation Ireland, the Arts Council, Irish Aid and Irish Human Rights and Equality Ireland.
Connecting for Life
Connecting for Life is Ireland's national strategy to prevent suicide 2015-2020. It is a cross sectoral strategy. A Cross-Sectoral Group comprising high-level representatives from Government Departments and key State agencies has been established to support the implementation of Connecting for Life. The Group monitors and evaluates implementation over time and provides clear communications channels across Government.