THE HEALTH Service Executive (HSE) is set to create a new structure of up to nine regional health authorities as part of a strategy to streamline the way it operates.
Managers of smaller, general hospitals will report to local health managers, who in turn will report to a regional manager.
The State's larger hospitals, which offer tertiary specialist care to patients, are likely to report to a single national director rather than a regional manager. It is likely the Liffey will no longer be used as a dividing line for Dublin's hospital services and that a single region for the capital will emerge.
The HSE is said to be sensitive about the creation of eight new regions, as this would equal the original number of health boards, leaving it vulnerable to accusations of a return to the status quo.
Sources have said the exact number of regions and the specific areas covered by each will be announced by Christmas. However, the division of responsibilities in each region is not expected to be decided in advance of further discussions within the HSE.
According to a draft document seen by The Irish Times, three new senior managers - a director of planning, a director of integrated care and a national director of clinical care and quality - would report directly to the HSE's chief executive, Prof Brendan Drumm.
The posts of national director for population health and national director of the office of the chief executive are to be abolished. The head of integrated care, who will replace the directors of the national hospitals office and the primary, community and continuing care directorates, will oversee a network of between seven and nine regional managers.
With the national directorates of the HSE to be reduced from eight to seven, a redundancy programme announced in the Budget may focus on employees working in human resources, finance and information technology.
The chief clinical officer, who is likely to be a senior hospital consultant, will oversee clinical governance groups at local level. These will be made up of clinical directors, to be appointed under the new consultant contract. Risk management, quality assurance and infection control are listed as clinical groups' key functions .
There is concern at plans to break up the directorate of population health, which oversees public health initiatives and preventive health, and to cede its functions to the three new directorates. But a source said this change would facilitate the implementation of a more patient centred service.
While some in the HSE see the changes as the key to rebuilding the health service around the patient and ending the perception of hospitals as the system's hub, some senior clinicians are concerned at the delay in creating a network of primary care services.