Healthcare, especially public healthcare provision, is a defining issue of our times.
While focus naturally falls on medical staff on the one hand, and patients on the other, the overarching governance frameworks in place within healthcare systems, can and do have a material effect on healthcare provision and outcomes, believes Alice Murphy, charities and governance partner at Mason Hayes & Curran.
It’s a topic she will explore as part of her keynote speech at the Future Health Summit, which takes place at the Dublin Royal Convention Centre on Wednesday, May 24th and Thursday, May 25th.
Mason Hayes & Curran, an award-winning business law firm employing over 570 staff, is a key sponsor of the event and has the largest healthcare legal team in Ireland.
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Murphy’s address will focus on how healthcare governance has ramifications not just for healthcare providers but for the public at large.
By way of example, she points to the debate last year over the National Maternity Hospital’s (NMH) planned move to a new site at St Vincent’s University Hospital in Donnybrook. The concerns arising have thankfully been comprehensively addressed, adds Murphy.
Many of Ireland’s biggest hospitals are charities operating in the not-for-profit sector, Murphy’s speciality. “What I do is help their boards to devise governance structures and processes, so that the hospital can work well operationally and be well governed,” she explains.
Murphy’s keynote address will provide insight into the way Ireland’s hospitals are governed and the importance of getting governance right.
In Ireland there are three different types of hospital provision. These include Health Service Executive (HSE) public hospitals, which are owned and funded by the HSE, voluntary public hospitals, most of whose income comes from State funds but which are independently governed. Ireland also has private hospitals, which receive no State funding.
In the voluntary hospital sector, each hospital has its own board, and follows a “very clear, hierarchical and well-defined structure”, she explains.
“It means you have a single hospital with a single board that knows everything about that hospital and is actively involved in its governance.”
Murphy’s address at next month’s Future Health Summit will focus on how healthcare governance has ramifications not just for healthcare providers but for the public at large
In the public hospital system by contrast, “you currently only have one board, and that is the board of the HSE”, she says.
For HSE board members, “any given hospital forms a small part of their work and to be charged with overall governance of our public healthcare system is a heavy burden, from tremendously committed board members”, she says.
Last year as part of Slainte Care, the government’s 10-year healthcare reform programme, the government approved the steps for setting up six new Regional Health Areas (RHAs) within the HSE. The idea is to ensure staff can provide locally planned and integrated services that are available closer to patients’ homes and that are governed regionally.
It is, believes Murphy, “a great move” and a timely opportunity for Ireland to also look at bringing corporate governance “closer to the patient in our public hospitals”.
RHAs are a structural reform to be welcomed, she believes. “The government approval of these Regional Health Areas goes back to 2019 and I’m sure if we hadn’t had Covid and the HSE cyber-attack, things would by now be further ahead,” says Murphy.
“To me, it’s about proximity and remoteness. Think of any example you care to mention, and you’ll see that governance being really far away from the point of service delivery poses challenges. That goes for patients being too far removed from the decisions that affect them too.”
Work on the roll-out of the RHAs is continuing apace, and Murphy poses some key questions which are presently under consideration. “What will the boards’ composition be? What will their legal structure be? Will they be statutory boards? How will they be populated?” she asks.
She believes particular rigour should be applied to board selection to ensure regional board members reflect a broad range of stakeholders. She again points to as the NMH, a client, by way of example. Its board includes medics, women who have had babies in the hospital, even Dublin’s Lord Mayor and is widely regarded as best in class.
The legal structure of the RHAs is important too. “It matters because it goes to status,” she explains. Hospital Groups, for example, were only ever established on an administrative, rather than a statutory basis, reducing their decision-making powers.
“RHAs appear to be a positive development,” says Murphy. “The challenge is to properly and fully implement them.”
For further information please see mhc.ie/health