HSE Established

The Health Boards

The Health Act 1970 established the eight Health Boards.  They were responsible for the provision of health care in their area.  They comprise local councillors, nominees of the Minister and representatives of health professional organizations.

The 1970 legislation made the Hospitals Council the central body responsible for the organization and development of hospitals.  The Hospitals Council was responsible for certain appointments in all hospitals, both health boards and voluntary hospitals.

1983 Commision on Funding

The role of the Health Boards was reviewed in the 1983 report of the Commission on Health Funding.  It is highlighted that many of the voluntary agencies funded by the Department of Health are not under the auspices of the Health Boards.  Voluntary hospitals accounted for over half of acute hospital services.  In addition, several voluntary organisations provide services to persons with disability.

This involved the Department of Health in managing services rather than dealing with policy implementation and monitoring. The commission recommended that the Minister and the Department of Health should formulate health policy and should not be involved in the management of individual services.

They recommended the establishment of a Health Service Executive authority. The reaction to the Commission’s report was largely negative.

Pre-HSE Steps

The Health (Amendment)( No.3) Act 1996 commenced the process of removing the Department of Health from involvement in operational matters. Funding of voluntary hospitals and voluntary organisations for persons with disabilities was taken over by the Health Boards from the Department. The Act improved arrangements regarding accountability and expenditure in the Health Boards and strengthened the role of chief executive officers.

The Eastern Regional Health Authority was established in 2000.  The Eastern Health Board was replaced by three area Health Boards.  It became responsible for all health and social services.  In Dublin Kildare and Wicklow. Aall voluntary hospitals and agencies came under the auspices of the ERHA.

The Eastern Regional Health Authority replaced the Eastern Health Board in the Dublin, Kildare and Wicklow areas.  This was replaced by the Health Service Executive.

Prospectus & Brennan Reports

The 2001 Health Strategy proposed a review of structures, which was undertaken by consultants in consultation with the Department.  The so-called Prospectus Report, the audit of structures and functions in the health service, was published in 2003.

It recommended changes to existing structures, which hindered a standardised approach due to variations in the organisational structures and practices of the Health Board.  It proposed the abolition of the Health Boards and the establishment of the Health Service Executive as a single national manager or entity.

The Report on the Commission on Financial Management and Control Systems in the Health Service (The Brennan Report) was published in 2003.  It recommended the establishment of an executive at the national level to manage the health services but recommended retention of the Health Board’s structure to safeguard local democratic input.

HSE Established

The Health Act 2004 established the HSE, replacing the Health Boards and many other agencies. The Health Act 2004 provided for a chairman and 10 ordinary members appointed by the Minister for Health.

The Health Service Executive took over the functions of the existing health authorities, the Health Boards.

The Health Services Executive is responsible for the operation of the health service. The Department of Health is responsible for policy and the strategic development of the healthcare system.  The Minister of Health appoints the board of the Health Service Executive.  The board appoints the chief executive.

Initial HSE Structure

The HSE comprised two principal Directorates, namely the National Hospitals Office and the Primary Community and Continuing Care Directorate.  The National Hospital Office was responsible for the allocation of resources, service delivery and performance management of the 50 public and voluntary hospitals.  There were 10 hospital network managers through whom it acts, which correspond to the former Health Boards.

The PCCC directorate was responsible for health and personal social services at the community level through 32 local offices.  The administrative areas for Directorates and other functions are divided into four principal regions; Dublin Midland Leinster, Dublin North East, South and West.

In each of the four areas, a Health Forum comprising elected representatives was established under the Health Act 2004.  Each City and County Council within the region returned representatives based on population.  The Forums make representations on a variety of health and personal social services in the region.  They have no formal executive role.

Wider Reform

The establishment of the Health Service Executive was part of a wider reform of health services.  The Health Information and Quality Authority was established.  New frameworks were established for governance, planning and reporting.

The establishment of the Health Service Executive was intended to be the first step in a five-year program of transformation of health services.  It contemplated a single service comprising doctors, hospitals and community care.

The Health Service Executive is responsible for health, personal and social services.  It absorbed more than 40 organisations and agencies providing health and personal social services. There are two so-called service pillars, the National Hospitals Office and the Primary, Community and Continuing Care Directorate.

Original Organisation

The Health Service Executive submitted business and service plans to the Department of Health. The chief executive is responsible to the government for the operation of health services and health spending and is answerable for accounts assets and the efficient use of resources.

There were three principal National Directorates. The National Hospitals Office deals with public hospitals and ambulance services.  It covers all acute hospitals. The Primary, Community and Continuing Care Directorate deals with community care.  The Population Health Directorate is responsible for strategic planning for the HSE, including health service delivery, health promotion, and protection.

The HSE is divided into a number of administrative areas.  The HSE Dublin Mid Leinster is responsible for South Dublin, Wicklow, Longford, Kildare, Westmeath, Laois and Offaly. HSE Dublin North East is responsible for North Dublin  Louth, Meath, Cavan and Monaghan.

HSE West is responsible for Connaught  Limerick, Clare, and North Tipperary.  HSE South is responsible for South Tipperary, Carlow, Kilkenny, Waterford, Wexford, Cork and Kerry.

Service Delivery

Services may be delivered directly or through voluntary hospitals, private providers, GPs and voluntary organisations. Community health care and personal social services embrace a range of nursing services, including home health, social work, and occupational therapy.

The HSE areas must provide service plans and budgets.  They are assembled into a national service plan.  The Department of Health sets national priorities, which are to be reflected in the plans.

There are a number of health forums to allow public participation, consultation and feedback.  There is a national forum and a regional health forum.  Members of the national forum include representatives of management, service providers, professional bodies, patient groups and others.

The regional forums allow local consultation and feedback on local issues of concern.  Members are nominated by Councils.  The forums make representations to the HSE on issues relevant to the area.

Having centralized health care management through the establishment of the HSE proposals existed as of 2008 to devolve powers and administration to regional directorates.  Each was proposed to have responsibility for healthcare in its locality. It was proposed to merge the NHO and PCCC directorates.

Health spending accounts for approximately one-quarter of total public spending. In 2009, over 130,000 people were employed in health services.

There are numerous agencies and bodies within the health services which have been established by law.  These include various boards and councils providing a range of services.

Further Changes

Arising from the McKinsey Review in 2008, the integration of two national service directorate posts into a single national Directorate dealing with integrated service delivery was effected.  The HSE appointed four regional directors to manage services within the four regions based on nationally set priorities and parameters.

The Fine Gael Labour Programme for Government 2011 envisaged the cessation of the HSE, the return of its functions to the Department of Health, and the provision of a universal health insurance system. See the separate articles on the post-2011 arrangements.