On 1 January 2005 the Health Service Executive (HSE) was established to manage Ireland’s public health sector as a single national entity.1 It replaced the former health boards, which had responsibility for 23 actions in the National Drugs Strategy, and joint responsibility for a further 11 actions. Responsibility for these actions has transferred across to the HSE. The new governance arrangements, whereby the chief executive officer of the HSE is now directly accountable to the Oireachtas for the performance and management of the HSE, may be expected to have an impact on drugs policy co-ordination and implementation.

The National Drugs Strategy outlines a three-tiered co-ordination structure, including the Cabinet Committee on Social Inclusion, comprising government ministers; the Inter-Departmental Group (IDG), comprising representatives from government departments, including the Department of Health and Children; and the National Drugs Strategy Team (NDST), chaired by an official from the Department of Health and Children and comprising representatives of departments, state agencies and the voluntary and community sectors.

The Mid-Term Review of the National Drugs Strategy addresses the question of where the HSE fits in to this co-ordination structure. It recommends that the IDG be expanded to include senior-level representation not only from government departments but also from the HSE (and other state agencies, including the National Advisory Committee on Drugs, the National Assessment Committee of the Young Persons’ Facilities and Services Fund and the Irish Prison Service), and from the voluntary and community sectors. The Mid-Term Review also recommends that both the Department of Health and Children and the HSE be represented on the NDST, but notes that the Department of Health and Children believes that it no longer has a role on the NDST.

Published in March 2005, the HSE’s National Service Plan (NSP) for 2005 outlines how the HSE intends to deliver its drug treatment services.  The management of all addiction services will be under the remit of the Social Inclusion Services, but the management of methadone treatment services also appears under the remit of Primary Care Services and the management of detoxification also appears under the remit of Mental Health Services.  Therefore, it is unclear who is responsible for which aspects of the addiction services at present.  The NSP emphasises that responses to the needs of those dependent on drugs or alcohol require a partnership approach across organisational boundaries, including drug task forces, together with clear strategies to prevent and reduce levels of drug or alcohol misuse and harm. The plan also endorses a needs-based approach to the delivery of services that minimises disadvantage.

A clear alignment with the National Drugs Strategy is established through the commitment made in the NSP to Action 22 of the national health strategy, Quality and Fairness, which states that all relevant actions in the National Drugs Strategy will be implemented by 2008.  Moreover, the NSP commits Addiction Services, within Social Inclusion Services, to providing six-monthly reports to the Department of Community Rural and Gaeltacht Affairs on the implementation of the National Drugs Strategy, supporting the Health Research Board (specifically the National Drug Treatment Reporting System), and implementing the work programme (i.e. report recommendations) of the National Advisory Committee on Drugs.

The NSP states that the HSE’s Addiction Services will monitor the two key performance indicators in the National Drugs Strategy that relate to timeliness of access to treatment services and access to treatment for under-18-year-olds. Specifically, these are:

·         Immediate access (within 3 days) to professional assessment and counselling by health board services and the commencement of treatment not later than one month following assessment.  One month is defined as 28 days. 

·         Development of age-appropriate guidelines on problem drug users aged less than 18 years and access to treatment (Jean Long, personal communication, 2005)

The NSP states that Addiction Services will also ensure the finalisation of the service users’ charter for drug initiatives. 

In June of this year the HSE is due to publish its first corporate plan, which will set out the HSE’s goals and strategies for the next three years. This plan may be expected to reveal more information about how the HSE will seek to implement recommendations in the Mid-Term Review of the National Drugs Strategy relating to:

·         an audit of the current availability of treatment options, including an assessment of treatment needs and methods of tracking ongoing developments, to be completed by mid-2006;

·         increasing the availability and range of drug-related treatment options, including detoxification;

·         expanding the provision of needle-exchange and harm-reduction services to ensure wider geographic availability and availability at evenings and weekends;

·         increasing the numbers of GPs and pharmacies participating in the methadone protocol.  

1. The Health Service Executive was established as a statutory body by the Health Act 2004.