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

taken their place. These new regions, however, do not seem
to reflect any recognizable, natural, physical or cultural
regional identity. One of them stretches practically the
length of the western side of the country from Donegal to
Limerick, and Dublin is split between two regions, with the
River Liffey as the boundary. The new system is intended
to facilitate vertical reporting from the local level to Dublin.
It might be expected that collaboration and integration
of action will be facilitated at the top; it is less clear how
improved collaboration is to be achieved at the local level
when all are reporting separately to Dublin. Along with the
weaknesses of the old system, it is possible that strengths
such as local people meeting on a regular basis, making the
horizontal links and working for the improvement of “their”
region could be lost.
The way that these radical changes were implemented, with
the creation of certain functions and jobs, has led to the
view, some three years later, that management structures
have not yet been sorted out. There is a perception that
it is impossible to clarify who is responsible for what and
consequently simple transactions with the HSE can become
stressful and time-consuming: one of the NGOs interviewed
stated that it can no longer reach decision-makers,
which would not previously have been the case.
Despite this difficult atmosphere, the HSE identified six
programmes of work. One of these was the development
of a framework for the management of NCD, approved
towards the end of 2008 (8). A support programme for
patients with chronic disease is already being implemented.
Written protocols and guidelines for treatment and evaluation
are being prepared. At the same time, an attempt is
being made to change the concept of performance evaluation
in the health services to focus more on outcomes.
Concern was expressed by one person interviewed that,
for small countries where resources are limited, organizations
such as WHO could offer more in terms of guidelines
on what does and does not work in disease management.
As a result of the Health Act 2007 (20), the Health Information
and Quality Authority was established on a statutory
basis, integrating the Social Service Inspectorate and
the Irish Health Services Accreditation Board. The main
aims of the new Authority are to develop safety and quality
standards and monitor their implementation; evaluate
the clinical and economic effectiveness of pharmaceuticals,
medical devices, diagnostics techniques and health promotion
activities; and provide information on the outcomes of
these activities.
2.4. Policies for specific NCD
2.4.1. Heart health
CVD is the largest single cause of death in Ireland, accounting
for 43% of all deaths. There appears to have been an
intensive and comprehensive attempt to deal with heart
disease over the last decade.
The 1994 umbrella strategy included specific targets related
to heart health. Given Ireland’s disadvantaged position compared
to other EU countries and the fact that lower socioeconomic
groups were more heavily burdened by coronary
heart disease (CHD), this was not felt to be enough. In the
south of Ireland, death rates from CVD were almost three
times higher in the semiskilled and unskilled working classes
than in the professional classes. In March 1998, the Minister
established a Cardiovascular Health Strategy Group to advise
on initiatives to improve cardiovascular health. All but
one of its members came from the health sector but they
consulted more widely, inviting written submissions and
meeting with representatives from other organizations.
The basic principles guiding the Strategy Group refer to the
achievement of health and social gain, including an environment
to support healthy choices. Equality was seen mainly
in terms of access to health services. To this end, a pilot
exercise commenced in 2005 to test standards for reflect-
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases