Gaining health : analysis of policy development in European ...

Chapter 4
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In 2004, there was an interim review of progress (16). The
review group concluded that there had been substantial developments
at both national and regional levels. Surveys of
lifestyles and behaviour had created a reliable database and
the health promotion workforce had grown considerably.
Interestingly, the CVD strategy Building healthier hearts (17)
had provided core funding for dedicated health promotion
posts and activities, thus prioritizing action to combat CVD.
There was found to be a high level of activity in settings
such as schools, communities, workplaces and hospitals (ten
hospitals had joined the health promoting hospitals movement).
The planned forum to coordinate intersectoral health
promotion approaches had not been established, however,
and it was felt that there was need for a stronger focus on
guidelines for partnership building.
Work has started on a new health promotion strategy, with
a particular focus on the health of children and the determinants
of inequalities in children’s health.
2.3. Health service policies
The umbrella policies referred to above, Shaping a healthier
future (10) and Quality and fairness (9), focus on the health
care system within the wider context of promoting and
protecting health. Recently, however, the health services in
Ireland underwent radical upheaval. This “transformation”
was considered necessary owing partly to the fact that
the previous Regional Health Boards were felt to be going
their own way, as local politicians developed local services
regardless of national needs and policies, thus making it
impossible to rationalize health care. The transformation
was also linked to a more general management reform in
the public sector.
An external consulting firm was brought in to audit the
structures and functions of the health system. The main aim
was to determine whether structures in the health system
were appropriate and responsive in integrating services
across the system, meeting consumers’ needs and focusing
sufficiently on the principles of the national Health Strategy
(18). Proposals were to ensure:
• clear lines of accountability and communication between
each part of the system;
• no overlap or duplication between organizations; and
• a proper alignment of the structure as a whole to the
vision and objectives outlined in the Health Strategy.
As a result, the role of the DoHC was to focus on health
policy. The 2004 Health Act proposed the creation of the
HSE, established in 2005, as the single body responsible for
meeting Ireland’s health and social care needs. This replaced
a range of about 40 different agencies, each of which was
independently answerable to the DoHC. It was hoped that
this transformation would facilitate more equal access to
quality care across the country. The new authority’s stated
priority was to give “increasing emphasis on Primary and
Community care and Health Promotion, by increasing preventive
intervention to keep people healthy” (19).
The HSE has three main divisions: population health;
primary, community and continuing care; and the National
Hospitals Office. From the organizational chart, it is not
clear how certain responsibilities are shared between the
DoHC and the HSE. For example, although the DoHC is
responsible for policy development, the Population Health
section of the HSE includes “develop public health policies”
among its tasks (12). Furthermore, although the DoHC
has an oversight role to “hold the system to account”, it is
not clear how this can be achieved when the HSE receives
funding directly from Parliament and is accountable for its
spending through that line of auditing. The DoHC does,
however, have to sign off on HSE business plans.
Consequently, in this centralizing move, the old Regional
Health Boards were abolished and four new regions have
Case studies: policy development in countries for tackling noncommunicable diseases