New HSE boss admits organisation is 'top heavy with many cumbersome processes' 

HSE chief executive Bernard Gloster said a key problem for patients was a lack of consistency in getting help around the country. Picture: Leah Farrell / RollingNews.ie

The HSE has become “a top-heavy structure with many cumbersome processes” the incoming chief executive Bernard Gloster told the Oireachtas health committee on Wednesday.

On Monday, there were 600 patients delayed in leaving hospitals due to gaps in support services or transfer processes, he said, adding this was not reasonable.

Starting from next month, 15 hospital CEOs and chief officers for community healthcare organisations will meet to discuss good practice and share what can be copied elsewhere, he said.

Mr Gloster, formerly head of the Tusla, the child and family agency, said a key problem for patients was a lack of consistency in getting help around the country.

Patients in Donegal, Dingle and Dublin should have similar access to care, he said.

“While there is enormous good to report in and about our services, I do not accept that as we work through 2023 with a budget of €21.6bn revenue and a workforce heading for 142,000 WTE (whole-time equivalent) that we are yet near to being that best we can be right now,” he said.

Mr Gloster will oversee the HSE’s move from community healthcare organisations and hospital groups to Regional Health Areas (RHA).

“Ahead of the RHA proposed changes, I have taken direct management responsibility for the HSE part of this change and to ensure we do not wait for that alone I have also introduced some interim significant management change processes to take effect in April,” he said.

He told Sinn Féin health spokesman David Cullinane he is proposing each RHA has a single lead with full responsibility and accountability, and they should be in place from early 2024.

Responding to questions from Social Democrats health spokesman Róisín Shortall, he said: “Accountability ultimately rests with me as the CEO.” 

He added there should be a “direct reporting relationship” between the RHA leaders and his office.

Mr Cullinane also asked why 49 beds of the 1,028 beds funded in 2020 for delivery will now not be delivered until next year.

Mr Gloster said this includes 24 beds for Cork. He accepted this was “not timely” and he is investigating what is causing the delay.

Regional health leaders will be more involved with the central HSE board under his tenure, he said.

This will benefit patients attending University Hospital Limerick and other overcrowded hospitals, he told Senator Martin Conway.

He added later that building new hospitals was not the only solution to overcrowding. 

“For me it’s capacity and process,” he said.

Referring to patients experiencing spiralling waiting lists and overcrowding, he said his five-year tenure should see improvements.

“If their experiences are not better, I won’t have done a good job,” he said.

Mr Gloster defended the pace of recruitment to Fine Gael TD Colm Burke, saying there had been a 19,500 net growth in staffing numbers between 2019 and December last year.

Referring to therapists, he said “over 2,000” extra roles are in the community, and he hopes this will lead to more clinical training places.

He praised staff for resilience in coping with the pandemic, the 2021 cyberattack and “one of the most challenging winters on record for health services”.

He predicted “a sea of change” in mental health services, telling Senator Anne Hoey that many changes were already in train.