The HSE has outlined how all care outside of hospitals will be organised and provided in the future, as part of the healthcare reform process.

A major HSE report on community healthcare services provides for the reorganisation of primary care (including GP services), social care (comprising older persons care and disability services), mental health services, and health and wellbeing.

The HSE claims the reorganisation will ensure that people receive "the right service, at the right time, in the right place, by the right team" and that as a result there will be better access to care and many people will not end up needing to use acute hospital services.

HSE Director General Tony O'Brien said the reform of these structures would facilitate a move towards a more integrated health care system, "improving services for the public by providing better and easier access to services, services that are close to where people live, more local decision making and services in which people can have confidence."

The reforms include:

* Establishment of nine Community Healthcare Organisations (CHOs)*.

* Development of 90 Primary Care Networks, averaging 50,000 population (one network for every large town/district), with each CHO having an average of 10 networks which will:

- support groups of primary care teams; and
- enable integration of all services for a local population.
- support prevention and management of chronic disease at community level.

* Reform of social care, mental health and health and wellbeing services to better serve local communities through:

- standardising models and pathways of care while delivering equitable, high quality services; and
- supporting primary care through the delivery of rapid access to secondary care in acute hospital and specialised services in the community.

The new community healthcare system was signalled in the White Paper on Universal Health Insurance (UHI) published earlier this year.

The planned new structures under UHI also include the eventual phasing out of the HSE, the establishment of a Healthcare Commissioning Agency, and the creation of hospital groups/trusts. Competing health insurers would purchase hospital and other services under the standard package of care to be covered by people's UHI subscriptions, under the plan launched by previous Health Minister James Reilly.

The Healthcare Commissioning Agency would retain responsibility for purchasing and funding services which fall outside the standard UHI package of care.

Since the replacement of James Reilly as Minister by Leo Varadkar, there is now some uncertainty over the timescale for the introduction of UHI, with the new Minister concentrating initially on providing free GP care for the whole population.

In order for this to operate effectively however, the community structures outlined in the new HSE report would presumably need to be put in place in the short to medium term.

It is unclear however, whether and when adequate resourcing will be provided to implement these new structures.

There may also be questions on how the plan for integrated care between community and hospital services will work with nine community healthcare groups but only six hospital groups (seven including children's hospitals).

* The nine new community healthcare organisations (CHOs) are:

Area 1- Donegal; Sligo/Leitrim/West Cavan; Cavan/Monaghan.

Area 2 - Galway; Roscommon;Mayo.

Area 3 - Clare; Limerick; North Tipperary-East Limerick.

Area 4 - Kerry; North Cork; North Lee; South Lee; West Cork.

Area 5 - South Tipperary; Carlow/Kilkenny; Waterford/Wexford.

Area 6 - Wicklow; Dun Laoghaire; Dublin South-East.

Area 7 - Killdare/West Wicklow; Dublin West; Dublin South City; Dublin South-West.

Area 8 - Laois/Offaly; Longford/Westmeath; Louth; Meath.

Area 9 - Dublin North; Dublin North Central; Dublin North-West.