Reconciling External Legitimacy and Organisational Implementation: the Case of Service Planning in the Irish Health Services

Whereas, in many OECD countries strategic planning in health care has been in evidence since the 1970s, in Ireland the emergence of strategic management processes in health care planning didn’t occur until the 1990s. The Strategic Management Initiative (SMI), as outlined in Delivering Better Government (1996), gives Government commitment to ‘the reform of our institutions at national and local level to provide service, accountability and transparency’ and forms the backdrop to the Irish public service reforms. One of the central mechanisms of the SMI is the devolution of accountability and responsibility from the centre to executive agencies. Service planning in the health sector is seen as part of this strategic planning ethos. That our health services need to be strategically planned is not in doubt, given that ‘health’ represents a large proportion (28.7% in 2005)(DOF 2005) of the Irish government’s spending. How this strategic management of our health services in the form of service planning, can be implemented, is the focus of a wider study. In analysing the evidence gathered thus far, this paper focuses on one aspect of this study; that organizations can appear to adopt modern reforms but in practice their implementation is more ritual than substantive (Lapsley 2001). Differentiating between the intentions of government in introducing service planning and the consequences of its implementation, allows examination of the impact of this reform using new institutionalist theory. Deploying this institutional perspective can reveal the use of management practices such as service planning, as legitimating devices. Despite the rhetoric of the national health strategy regarding the inclusive involvement of staff and the wider community, service planning is located within a system of top-down control