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Cathal Magee

Cathal Magee. Chief Executive, HSE. The Challenge of Health Service Reform. Cathal Magee Chief Executive Officer Health Service Executive. Context. Population growth (17% since 2002) Ageing population– over 65s costs expected to rise by 2% each year for next 5 years

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Cathal Magee

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  1. Cathal Magee Chief Executive, HSE

  2. The Challenge of Health Service Reform Cathal Magee Chief Executive Officer Health Service Executive

  3. Context • Population growth (17% since 2002) • Ageing population– over 65s costs expected to rise by 2% each year for next 5 years • Adults with chronic conditions will increase by 40% by 2020 • Invasive cancers projected to increase 6% annually for females and 8% for males • Acute & non acute activity demand continues to rise • Incumbent models of care struggling to keep up

  4. Objective • improve access to care • improve the quality of care • bring down the cost of care

  5. Start with the basics “The Good-to-Great companies had no name, tag line, launch event or programme to signify their transformation. Yet, they produced a truly revolutionary leap in results, but not by a revolutionary process.” Jim Collins “Good to Great”

  6. Leading Change • Where are we? • Where do we want to go? • How ready are we to go there? • What do we need to do to get there? • How do we manage the journey?

  7. Where are we? • Finance • People • Management • Organisation

  8. Finance

  9. Irish Output Source: CSO National Income & Expenditure 2010

  10. Irish Public Health Expenditure Source: Department of Health & Children. Health In Ireland: Key Trends 2010.

  11. Irish Output and Public Health Expenditure

  12. Public Health Expenditure as % GDP Source: The National Recovery Plan 2011–2014. DoHC Key Trends 2010, CSO National Income & Expenditure accounts

  13. Net Funding to HSE

  14. 20% Total Health Spend Comparisons - Per Capita ** Source: OECD Health Data 2011.(based on 2009 figures) ** The Irish data includes social expenditure which is estimated at 20% of total health expenditure.

  15. People

  16. General Support Staff Other Patient & Client Care Medical /Dental Management /Admin 17% 10% 8% 15% 35% 15% Health & Social Care Professionals Nursing Health Disciplines- 2011

  17. 112,771 WTEs 104,511 WTEs 90,302 WTEs Resource Levels 2001 -2011 – Health Service

  18. Resource Levels 2001 -2014 – Health Service

  19. Capacity – 2001 to August 2011

  20. Health and Social Care Professionals2001 to 2011

  21. 18,421 WTEs Management/Admin 16,066 WTEs 14,714 WTEs Management/Admin – 2001 to 2011

  22. Management

  23. 4% 6% 17% 43% 27% Management/Admin – August 2011

  24. Management • Administration is a required core competence • Administration is not management • Need to strengthen the management system • Separate the career streams • Investment in management a strategic priority • Interim solutions required

  25. Management • Who is ‘Management’ in our health system? • Management and administrative • Medical leaders • Nursing leaders • Allied health professional leaders

  26. Executive Management • Line • Operations • Financial • Procurement • ICT • HRM Delivery of Clinical Services and Patient Care

  27. Clinicians in Management • Health services is a clinical environment • Need reform in the actual delivery of healthcare • Clinicians at the centre of re-engineering and managing • Management to be core part of clinicians development • Need to create and support an enabling environment

  28. National Clinical Programmes • Clinically led multidisciplinary team • Structured programme management approach • Nationalise existing best practice • Engage patients • Align stakeholders • Make data driven decisions • Local ownership of implementation

  29. Scale of National Clinical Programmes .

  30. Unlocking High Performance in Healthcare ‘the leadership needed to transform the performance of hospitals and health systems must come principally from doctors and other clinicians whether or not they play formal management roles’ McKinsey & Co.

  31. Organisation

  32. High Discipline Low High Change

  33. HSE • Scale, scope, complexity, geography • Complexity of designing basic architecture • Existing operating model too centralised • Service delivery requires local leadership • ‘Ownership’ in the frontline • Frontline to be connected, responsive, authoritative

  34. Front Line Delivery Units Hospital / Health Care Networks Enterprise Support / Shared Services Planning & Commissioning Policy Unbundle & Invert

  35. The Challenge of Sustainability • Economic • public health services spending with reference to our ability to fund • Delivery of services • the capacity of health services to come through the reductions in money and people • Change • change which will protect and improve our health services

  36. The Challenge of Sustainability • Traditional “steps” to reform will not work • Changing the way we change • Concurrent action based strategic management • Maintain focus on services to patients and clients

  37. “The Good-to-Great companies paid scant attention to managing change, motivating people or creating alignment. Under the right conditions, the problems of commitment, alignment, motivation and change largely melt away.” Jim Collins Good to Great

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