Understanding service reorganisation in the Irish health & social care system from 1998 to 2020: lessons for reform and transformation

Abstract

Background: Given policy drives for integrated care and other reforms requiring service reorganisation this study analyses service reorganisation in the Irish health and social care system from 1998 to 2020 with the aim of identifying lessons for reform implementation and system learning generally. Methods: A mixed-method, co-designed study of three distinct datasets through in a policy document analysis, a thematic analysis of interviews with elite respondents, and a formal review of the international literature, sets the Irish reorganisation story in the context of services and system reorganisation elsewhere. This approach is apt given the complexity involved. Results: We find repeated policy declarations for forms of integrated care from the early 1990s in Ireland. These have not resulted in effective change across the system due to political, organisational and implementation failures. We identify poor clarity and commitment to policy and process, weak change management and resourcing, and reluctance from within the system to change established ways of working, cultures and allegiances. Given its narrative approach and identification of key lessons, this study is of use to policy makers, researchers and practitioners, clinical and managerial. It forms part of a bigger project of evidence building for the implementation of Sláintecare, Ireland’s 10-year health system reform programme. Conclusions: The paper captures important lessons for regionalisation of services delivery and other reorganisations in service-based systems more generally. We find evidence of a negative policy/implementation/practice cycle repeatedly missing opportunities for reform. Learning to break this cycle is essential for implementing Sláintecare and other complex reorganisational health reforms generally.