A redundancy scheme may have to be introduced by the HSE following its latest proposed shake-up which will see its services devolved and delivered by six regional authorities.

It is understood the plan for the overhaul involves fewer staff and a reduction in the overlap of services, particularly in the community area.

It is understood the Cabinet will be presented with the proposals at tomorrow's meeting which will see the HSE carved up into six new geographical boundaries to deliver more services at local level, devolving more autonomy for decision-making.

It is unclear what level of control the regional authorities will have over funding which will be crucial.

Currently, the HSE is split into nine community healthcare organisations and six hospital groups.

A spokesperson for the Department of Health said that the proposals were in keeping with the Sláintecare plan which said that the HSE should have national functions but be divided into regional-level authorities.

"While significant progress has been made by community health organisation and hospital group structures, there is broad consensus that having separate and unaligned structures for acute and community care impedes the development of a more integrated health service."

The department has carried out detailed analysis work to determine the optimal geographical alignment of community health organisations and hospital groups.

"Proposals are being brought to Government very shortly regarding the geographical areas of new bodies, together with the findings of the public consultation, which are expected to be published shortly after a Government decision."

Briefing documents to the HSE's new director general Paul Reid in May noted there was "overlap and confusion" in parts of the community care system.

Some are described as "operating in isolation" and in an "uncoordinated manner with results that either duplicate or are counter-productive to the wider objective".

Other problems in community care groups are said to be "unclear or inadequate service architecture, governance structures, reporting systems, processes and measures".

When the HSE was set up in 2005, replacing the health board system, it was criticised for holding on to the same number of staff and not looking at ways of introducing payroll efficiencies.

The HSE is currently imposing limits on spending on the hiring of new staff.

This has meant that job applicants who were told they were being recruited are having to be put on hold.

A spokeswoman for the HSE said that the purpose of the controls was to ensure that the HSE was demonstrating it was living within the available resources provided to it by Government.

This does mean that in some hospital groups and community health organisations, non-critical replacement posts will be paused.

"There is on-going capacity to recruit new funded posts and also to replace critical clinical posts.

"These controls will remain in place pending further assurance of the capacity to manage within budget as set out in the National Service Plan 2019. On receipt and acceptance of balanced plans these additional controls can be reviewed and removed where appropriate," the spokeswoman added.

Irish Independent