NSR III - BIPS

Conclusion
The organisational reform of Irish Health Service currently ongoing has given
rise to additional uncertainties and frustration for staff on the ground. The
reform certainly created uncertainty for the executive of this project work.
There is an often repeated mantra of not knowing how jobs will be configured
with reporting lines unclear in many cases. The previous example of the
three regional health authorities in the Dublin area and the length of time it
took for the merging of these bodies to be completed and bear fruit does not
bode well for the current larger scale reform.
Improved mechanisms for information sharing should contribute to greater
clarity and visibility of Smoking Cessation Officers and their work. In the
interim period, however, smoking cessation officers continue to work in an
isolated manner, with poor information sharing at either regional or national
level.
Community Development work has a role to play in motivating communities
towards greater responsibility and care of health in the community. This is an
issue for policy makers and the promotion of active citizenship.
Engaging communities in the development of health policy planning and the
design, delivery and ongoing monitoring and evaluation of health services is
good practice and means that the social determinants of health are more
likely to be considered. When the social determinants such as housing,
employment, poverty, education, access to health and other elements such as
resources available to communities, gender, age and ethnicity are taken into
account it becomes very evident that differences in health outcomes are
closely related to one’s experience of these determinants.
It is hoped that the reform of the health services, with the clear demarcation
between policy making (Department of Health and Children) and service
design and delivery (Health Services Executive), will bring clarity to smoking
cessation strategies and outcomes at national, regional and community level.
In January 2005 the eleven previous health board entities - each with their
own governance, management and information systems – were rationalised
into four regions. This move should, in the longer term, streamline delivery
of services and facilitate easier information sharing across the regions. There
is, however, clearly a transition period during which uncertainties impact on
motivation and clarity for those providing services on the ground.
As smoking cessation falls within the new Population Health Directorate of the
HSE there will be much work needed to bed in the various strands of work
and align the various strategies within their new locations. When this
consolidation is achieved there will be an opportunity for smoking cessation
work to become more visible at both Local Health Office (LHO) and regional
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