Revitalisation, Rigour and Relevance: The Citizen-Client and Planning in the Health Services.

Abstract

Whereas, in many OECD countries strategic planning in health care has been in evidence since the 1970s, in Ireland the emergence of strategic management processes in health care planning didn’t occur until the 1990s. The Strategic Management Initiative (SMI), as outlined in Delivering Better Government (1996), gives Government commitment to ‘the reform of our institutions at national and local level to provide service, accountability and transparency’ and forms the backdrop to the Irish public service reforms. One of the central mechanisms of the SMI is the devolution of accountability and responsibility from the centre to executive agencies. Service planning in the health sector is seen as part of this strategic planning ethos. However, ten years since the advent of service planning there has been no real shift in alignment of resources with needs. How can the strategic management of the Irish health services in the form of service planning be implemented? The focus of this paper is the identification of stumbling blocks to success in this endeavour. These include the limitations of the control mechanism, the legislation, underpinning service planning and the lack of recognition of the complexity of the healthcare environment and the stakeholders within it, in attempting to introduce service planning as a means of strategic management. This paper reports on part of a comparative study of health services planning in Ireland and in Canada. The Irish research is shadowed by a case study in Canada. This paper reports on the Canadian experience of public participation in planning, to align goals and targets with identified health needs in the population. In comparison to the Irish context, the Canadian planning system takes a two pronged approach; a population health planning approach at the corporate strategic level and multiple stakeholder involvement which is protected by legislation, feeding into this system on an annual basis.