HSE's Six-Region Restructure Shows 'Patchy' Results Two Years On, Board Warns
The Health Service Executive's restructuring into six health regions — the most significant reorganisation of Irish healthcare in a generation and a central pillar of the Sláintecare reform programme — has produced results that the HSE board itself describes as "patchy" and "variable" two years after implementation, with governance tensions, financial pressures, and inconsistent performance across regions raising questions about whether the model is delivering the improvements in care that were promised.
Background
The decision to restructure the HSE into six health regions was taken as part of the Sláintecare 10-year plan, the cross-party blueprint for transforming Irish healthcare that was adopted by the Oireachtas in 2017. The restructuring, which took effect in 2024, replaced the previous system of nine community healthcare organisations and seven independent hospital groups with a unified model of six regions, each led by a regional executive officer with responsibility for integrating hospital and community services across their area.
The rationale for the restructuring was compelling. The previous system was widely criticised for its fragmentation, with hospital groups and community healthcare organisations operating in silos that made it difficult to provide integrated, patient-centred care. The six-region model was designed to break down those silos, giving regional leaders the authority and the resources to develop services that met the specific needs of their local populations, rather than being driven by the priorities of a centralised bureaucracy in Dublin.
The six regions — Dublin and North East, Dublin and Midlands, South East, South, West and North West, and Saolta — each cover a substantial geographic area and a population of between 500,000 and one million people. Each region is supported by a network of 20 Integrated Health Areas, which are intended to provide a further layer of coordination between hospital and community services at a more local level.
Key Developments
The Irish Times reported on Monday on an assessment of the six-region model two years after its implementation, drawing on HSE board minutes, external reviews, and interviews with healthcare professionals and administrators. The picture that emerges is one of genuine progress in some areas, but significant challenges in others.
The HSE board noted in April 2026 that the operation of the regions appeared "patchy" and "variable," with some regions performing well and others struggling to manage financial and operational pressures. The board expressed concern about the capacity of some regions to manage their budgets effectively, and noted that the shift to regional funding — with each region now responsible for its own financial management — had proven challenging in practice. Some regions have faced fiscal difficulties, leading to the escalation of financial controls and mandates to reduce reliance on external agency staff.
There is also a persistent tension between regional autonomy and the need for central coordination. The board has expressed concern that the current model sometimes results in reduced visibility at the centre, making it difficult to maintain a consistent view of performance across the system. Stakeholders, including the Irish Voluntary Healthcare Association, have noted that the focus required to establish new leadership teams and structures has, in some instances, delayed progress toward the broader goals of Sláintecare.
Why It Matters
The performance of the six-region model matters because it is the foundation on which the entire Sláintecare reform programme rests. If the regional model cannot deliver the integrated, patient-centred care that was promised, the broader ambitions of Sláintecare — universal access to healthcare, reduced waiting times, improved outcomes — will not be achieved. The "patchy" results identified by the HSE board suggest that the model is not yet delivering consistently, and that significant work remains to be done to realise its potential.
The financial pressures facing the regions are also a concern. Healthcare is expensive, and the demand for services is growing as Ireland's population ages and as the burden of chronic disease increases. If regions are struggling to manage their budgets within two years of the restructuring, the financial sustainability of the model over the longer term must be questioned. The government has committed to funding the Sláintecare programme, but the scale of the investment required is substantial, and the competing demands on the public finances are significant.
Unlike the NHS in England, which has undergone multiple restructurings over the past two decades with mixed results, Ireland's six-region model is still in its early stages. The evidence from England suggests that healthcare restructurings take many years to deliver their full benefits, and that the transition period is inevitably difficult. The question is whether the Irish government and the HSE have the patience and the resources to see the model through to maturity.
Local Impact
For patients across Ireland, the performance of the six-region model is not an abstract governance question — it is a matter of whether they can access the care they need, when they need it. In regions where the model is working well, patients are beginning to experience the benefits of more integrated care, with better coordination between their GP, their community health team, and their hospital. In regions where the model is struggling, patients may find that the restructuring has added a layer of administrative complexity without delivering the improvements in service that were promised. The HSE has committed to publishing regional performance data on a regular basis, which will allow patients and the public to assess how their region is performing relative to others.
What's Next
The HSE is expected to publish a mid-term review of the six-region model before the end of 2026, which will assess progress against the targets set out in the 2026 National Service Plan and identify areas where additional support or intervention is needed. The review will be informed by the HSE board's assessment of regional performance and by feedback from healthcare professionals, patient advocates, and the public. The government has indicated that it remains committed to the six-region model as the framework for healthcare delivery in Ireland, but has acknowledged that the transition period has been challenging and that further investment in regional leadership capacity is needed.
