The HSE is set for a massive shake-up after Health Minister Simon Harris warned that its governance structure was preventing him from discharging his duties.
Mr Harris intends scrapping the health authority as part of a plan for the future of Ireland’s healthcare.
Of more immediate concern, however, is the HSE’s governance structure and Mr Harris does not want the current situation to continue. The minister told the Oireachtas Committee on the Future of Healthcare that measures to improve governance were urgently needed.
“I do not believe the current governance structure is in any way adequate for me to discharge the function that the House [Oireachtas] expects me to discharge,’ said Mr Harris.
The chair of the committee, Roisin Shortall, said that the committee was very concerned about the lack of independent oversight of the HSE and the fact it did not have an independent board.
“That is a matter of serious concern. It is very hard to see how that issue could be addressed, without addressing the organisational structures at the same time,” she said.
Mr Harris said that the HSE director general was currently responsible to the authority’s directorate for the performance of his or her functions but many of the members of the directorate were actually subordinate to the director general.
During his presentation earlier, Mr Harris, said that subject to the committee’s report, he intended asking his department to come forward with proposals to improve governance arrangements for the HSE for so long as it continued in its current form.
“This will include an examination of the current vesting of governing authority in the HSE directorate, including the fact that the current director was responsible to the directorate for the performance of his or her duties.”
Mr Harris believes there is a “shared frustration” between the HSE, the department and himself about the current governance arrangements. It was an issue that needed to be tackled as they set about making the HSE a “much leaner” body.
He said the HSE should be more equipped to lead than to directly control and with fewer management layers between the top and front line. Staff were also impacted negatively by structures that placed too many layers between leadership and frontline staff.
He wants to further develop hospital groups and community health organisations, align them geographically and, as they developed, devolve greater decision-making and accountability.
Once statutory responsibilities and accountabilities are devolved from the centre to hospital and community health organisations, the HSE would be dismantled and replaced with a much leaner national health agency.
In the interim, existing legislation in which the HSE operates will be reformed to improve governance.
Mr Harris said that in devising a strategic way forward, they would have to bear in mind that, at any given point in time, there would always be limited resources available.
“That is just a reality. But I think we all agree that we need to do better than we are doing at present. To do so, we must have better systems in place to guide us in setting priorities and allocating finite resources.
“Over the next decade, we need to get past the stage of constant fire fighting to a place where we can have a mature debate about how to set priorities and where to develop our services.”
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