Reforming Ireland’s health service

The Public Health Reform Expert Advisory Group has reviewed Ireland’s approach to health policy and produced a report recommending a suite of measures as to how the State can now strengthen systems to ensure a comprehensive approach to public health.

Published in September 2023, the report is an amalgamation of research carried out by a number of expert groups. The report makes recommendations on different areas of public health policy.

Learning from Covid

On strengthening preparedness for future pandemics and other public health threats, the report recommends that pandemic preparedness and public health emergency preparedness become a stronger part of a strengthened health protection strategy, with formalised cross‑government, cross‑sectoral and inter‑agency links, making full use of national structures for emergency planning and management.

It is further recommended that Ireland fully participates in international mechanisms and the implementation of international agreements and treaties arising from Covid‑19. This activity should include the development of updated plans for known health threats and more general activities to build health system resilience and adaptability.

Furthermore, research into pandemic preparedness should be increased and supported through national and international mechanisms, the advisory group asserts.

Improving mental health

On achieving a comprehensive national public health strategy to guide coordinated delivery of the essential public health functions in order to protect and promote long and healthy lives across Ireland, the most striking recommendation is that the Department of Health needs to develop a mental health strategy.

“A new national public health strategy, led by the Chief Medical Officer, should be developed by the Department of Health to provide a coherent approach to the full set of essential public health functions,” the report states.

“The Department of Health should engage across government and sectors to develop this strategy. It should also engage with the Health Service Executive (HSE), and other agencies engaged with public health activities. This should bring together, build on and further develop existing strategies across health intelligence; health service improvement; health protection; and health and wellbeing.”

To enable this, a programme of updated and strengthened public health legislation should be developed including full implementation of the International Health Regulations, legislation to underpin new public health roles and functions, and the independence of public health advice.

Benchmarking progress

The report asserts that the new public health strategy should include an agreed public health outcomes framework building on and further developing existing public health outcomes frameworks in place for Healthy Ireland, the Sustainable Development Goals, the Government’s Wellbeing Framework, and the Health System Performance Assessment Framework.

An annual progress report on the delivery of the public health strategy monitoring the agreed outcomes, would need to be published by the Department of Health and delivered to the Government.

“A new national public health strategy, led by the Chief Medical Officer, should be developed by the Department of Health to provide a coherent approach to the full set of essential public health functions.”
Public Health Reform Expert Advisory Group

The proposed national health information authority should be codesigned with those working in public health to support the monitoring of agreed public health outcomes, provide data to give insights on public health priorities, and work in close collaboration with bodies working towards improved public health outcomes.

Alleviating health inequalities

To alleviate health inequalities, there is a need build on the dialogues formed during the pandemic with communities across Ireland to institute a continuous, formal process for listening to their priorities, according to the Public Health Reform Advisory Group.

From this, there is a need to ensure that the public health strategy and all policies within it prioritise better supporting those with the worst public health outcomes.

Making this work across the State will involve the development of a clear, integrated approach at local level to continuous engagement with and support of “the public and vulnerable groups” towards the improvement of their health outcomes and experiences, guided by their priorities.

Making health policy a cross-government priority

This will require Department of Health to lead cross‑sectoral mechanisms to ensure preparedness for future public health emergencies, embed public health in policies across government, address health inequalities, and enhance recognition of population health as a national asset.

Public health impact would have to be considered as part of major new policy developments across government. The report asserts that public health should be embedded in all policies, in a manner analogous to the way the climate crisis is being embedded across policy areas through the Climate Action Plan.

Health leadership

Emphasising the importance of strong leadership, the report states that public health expertise and representation at national, regional, and local levels should be strengthened and embedded in line with the implementation of the Crowe Horwath recommendations, Sláintecare, and the implementation of the regional health areas. It further stipulates that this should include the appointment and alignment of key public health roles at national and regional levels building on recruitment that is already underway.

Lines of management and communication must be clearly drawn as the regional health areas are developed in order to allow the national leads to support those working regionally, and for those working regionally to learn from each other’s challenges and successes through a formal learning and communication process.

Ensuring a coordinated approach

A strategic workforce plan, learning of which can be drawn from the one in the English National Health Service, should be developed to underpin the delivery of the 12 essential public health functions at national, regional, and local levels. This should include planning for surge capacity, including the development of a public health reserve corps.

There is a call for a wider recognition that the impact the pandemic has had on the health workforce and focus on enhancing health service staff’s wellbeing and resilience, and on recruitment, training, development, and retention.

The Department of Health and agencies would need to fully engage with the EU, its agencies, and other international bodies including the World Health Organization (WHO) and the Organisation for Economic Co‑operation and Development (OECD) to ensure access to international expertise, practical mechanisms, supports for dealing with cross‑border health threats, and learning opportunities for the public health workforce.