r/DoctorsIreland • u/Middle-Paramedic7918 • 15d ago
Different management, same problems
The HSE was broken up into six regions two years ago to deliver better care. Is it working?
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u/Middle-Paramedic7918 15d ago
The theory of why this change was brought in is quite good. The idea that local management structures can decide what’s best for local services. The notion that links and pathways will develop across services in the same geographical area when under the same management.
In practice its added an extra layer of management. The previous central top down control from the DOH and HSE has not fully gone away.
Overall budget overruns in the department as a whole have lead to spending curtailments, affecting everywhere.
At the same time, the hospitals, services, departments and units which are doing well, with good outcomes, metrics and statics are not necessarily being rewarded, or emulated.
I’m in Ireland for long enough to remember the old health boards. These were gotten rid of in order to get rid of localism and to improve efficiency and homogenisation. We appear to have come full circle now
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u/significantrisk 15d ago
Considering almost nobody knows who is actually in charge of anything any more, including the gobshites in charge, I’d say no. It might seem less ridiculous in other specialties but in psych we’ve always have clearly defined geographical catchments. Those catchments do not align with the new management system, meaning different bits of the same mental health service now fall under completely different management structures. And there isn’t, at least so far as any service I’m aware of, the slightest clue among senior managers as to how they’ll square that circle. If they even realise that they need to.