The Health Service Executive was established under the Health Act 2004. The body was established as an independent body corporate. Its objects and functions were set out. It was required to use resources available in the most beneficial, effective and efficient manner to improve, promote and protect health and welfare of the public. It assumes the functions of a number of bodies which were dissolved in so far as they related to the planning, delivery and operation of health and personal social services.
The Executive is obliged to manage and deliver such services or arrange for other bodies to do so on its behalf. It must facilitate education and training of health service personnel and must have regard to the need for cooperation with other public authorities. It must have regard to public policy and provide advice to the Minister when requested. It has authority to commission and take part in the research on issues relevant to its functions.
The Executive may enter into agreements with public and local authorities to perform functions on its behalf or vice versa. The Minister may give general directions to the Executive as appropriate in relation to it statutory functions. The Minister may give specific directions about submissions by the Executive to the Minister of reports and information in relation to his functions.
The Board and governance of the HSE was reformed in 2012 by the Fine Gael Labour coalition which took office in 2011.The Executive has a Board consisting in its original form of 11 members appointed by the Minister and a Chief Executive. There are the standard restrictions on Board members holding certain offices, which are incompatible with Board membership.
The functions of the Executive other than those vested in the medical officers for health are vested in the Board. There was provision for delegation of functions to the Chief Executive Officer. The Minister may remove a member of the Board from office. Persons are to cease to hold office in certain circumstances. The Minister may remove Board members with reference to the manner in which functions are being performed. A person may be appointed to conduct a review of issues.
The Board may establish committees to assist and advise it in relation to matters arising in the performance of its functions. There are procedures for the establishment and operation of committees.
There are requirements for the Board Committees, Chief Executive Officer, employees and advisors to maintain appropriate standards of integrity and conduct. The Executive is to issue codes of conduct for their guidance. Confidential information must not be disclosed by the board, committees, employees, advisors.
The Executive may appoint employees and determine their functions and duties subject to conditions. The Executive must prepare a superannuation scheme for the approval by the Minister for Finance.
The Executive must prepare three-year corporate plans. It must be submitted to the Minister for approval. There are provisions for amendment. The plan must have regard to government policy. It must specify the objectives of the Executive for that period.
There are requirements regarding publication and implementation of a plan. The Executive must provide progress reports on its implementation annually to the Minister.
The Executive must prepare and adopt a service plan specifying services to be provided for units\’ financial limits as determined by the Minister for the financial year in respect of noncapital expenditure. There is provision for approval of the plan. The Minister may direct amendment to the plan. The Minister may determine priorities to which the Executive must have regard.
The Executive is obliged to deliver services in accordance with its service plan within its noncapital expenditure allocation. The Executive may borrow money with the consent of the Minister and concurrence of the Department of Finance. The Minister specify maximum indebtedness which may be incurred.
There are provisions regarding allocation of capital spending and accountability. The Minister is to inform the Executive of the total capital amount available in the financial year and the Executive must prepare a capital plan in accordance with it. There is provision for amendment of the multiyear capital plan.
The Minister may make grants to the Executive. The consent of the Minister is required for undertaking capital projects above an amount set by the Minister from time to time.
The Chief Executive Officer is responsible for implementation of the executive service plan and capital plan. He must inform the Board of any decisions which will breach the limits. If the Board does not take steps to ensure this does not occur, the Minister must be informed.
The Executive must submit a code of governance for approval by the Minister. It is to be reviewed periodically. The Executive is to make arrangements to report on compliance.
The Executive must keep accounts of income and expenditure and prepare any others statement. They are to be adopted by the Board annually.
The Board is to prepare an annual report in relation to the performance of its functions during the preceding year. It must submit it to the Minister who must lay it before the Houses of the Oireachtas. The Executive must publish its annual report.
The Executive may make arrangements with other entities for the provision of services. The legislation specifies conditions applicable to such arrangements. The Executive must inform the service provider of the funding available annually and the level of the services required.
Service providers must submit accounts in respect of services they provide to the Executive. The Executive may dispense with this requirement for providers in receipt of grants below a certain amount.
The Minister must convene a national health consultative forum to advise him on matters relating to health and personal social services. He may specify provisions regarding his membership, rules and procedures.
The Minister may establish four Regional Health Forum. The Forums makes representations to the Executive as it considers appropriate regarding the delivery of health and personal, social services.
A Forum is to be composed of members of each city and County Council within the region. The Minister is to make regulations regarding the establishment and operation of the Forum. The Executive may provide administrative and other support to them.
The Executive may consult with local communities or groups about health and personal social services. This includes establishment of panels to advise the HSE, to enable it ascertain and seek views of users, service providers and others. The Minister may direct the Executive to establish an advisory panel for a particular purpose and determine its terms of reference.
Complaints may be made about actions of the Executive or service providers which do not accord with fair and sound administrative practice and which adversely affect the complainant. Actions which do not accord with fair and sound administrative practice are defined.
Provision is made for complaints to be made on behalf of persons unable to do so because of age, disability or illness or in the case of deceased persons.There is a time limit applicable to making of complaints which may be extended in exceptional circumstances.
The HSE must establish a complaints procedures in respect of its own services or those provided by other entities it retains. Such bodies may provide their own complaints procedures with the agreement of the Executive. The Minister may assign its duty and functions to another entity.
Vexatious complaints are to be dismissed. Complaints will only be considered if they are within certain criteria. A complaint may not be accepted which would require amendment of the executive service plan or under a body\’s arrangement with the Executive for service provision on its behalf.
Bodies providing services for the Executive must have an equivalent complaint procedure. Regulations may be made for the purpose of the provisions in relation to complaints.
A person dissatisfied with a recommendation made pursuant to a complaints procedure or an action taken in response to a complaint may bring a complaint if appropriate to the Ombudsman or the Ombudsman for Children.
The Executive signing a report is to include a report on the operations of its complaints procedure during the year. A service provider must report on its own complaints procedure. If a third-party body is assigned to deal with complaints it must make a report annually to the Executive on its functions and work in this regard.
The 2004 Act dissolved certain existing health bodies and transferred their assets and employees to the HSE. Existing superannuation benefits were preserved. It assumed the Health Boards’ and the Eastern Regional Health Authority\’s assets and responsibilities which were transferred to the Executive.
The Minister may dissolve various corporate entities within the existing health system established under Health (Corporate Bodies) Act, 1961 and transfer their assets and responsibilities to the Executive.
References in existing legislation to the previous bodies are to refer where appropriate to the Executive.
The Health Service Executive (Governance) Act 2013 gives effect to the major changes in the HSE Board and structure arising from the change of government in 2011. The program for government had committed to the eventual dissolution of the HSE as part of health care reform program. Accordingly, the legislation was introduced as transitional in nature.
The Act abolished the Board and CEO structure of the HSE and provided for a Directorate as the new governing body in place of the Board. It is headed by a Director General. There are further accountability arrangements for the HSE. A number of related and technical matters were provided for.
The Minister is empowered to give general directions to the HSE under the Act and to give specific directions on the submission by the HSE of reports and information in relation to its functiona. Ministerial directions may be given in relation to implementation of government policy and objectives where the Minister believes that the HSE is not having sufficient regard to them in performing its functions. Directions may not be made in respect of individual patients or service users.
The Minister was given further power to determine priorities to which HSE must have regard, in preparing its service plan and establishing performance targets. Before specifying targets and priorities, the Minister is to have regard to best practice in relation to the service concerned, outcomes for patients and recipients likely to be affected by the priority or performance target and the effect of specifying the priority or performance target concerned would be likely to have on other services provided by the HSE.
The Minister is to consult with the Minister for Children and Youth Affairs in setting priorities or before specifying priorities on performance targets which relate to the functions of the Minister for Children and Youth Affairs.
The governing authority is the Directorate. It has authority to carry out the HSEs functions. The Directorate consists of a Director General and other persons who are appointed as Director.
There is no fixed number of Directors but there is a maximum of seven and minimum of three. The Director-General is automatically a member and chairperson of the Directorate. Others are appointed from amongst HSE employees who hold positions of National Directors in the HSE. The terms of directorships are specified as three years. They may be reappointed.
The Directorate has collective responsibility as governing authority of the HSE. It may delegate functions to the Director-General. It is responsible collectively and is subject to the direction of the Minister. The Directorate is accountable to the Minister for the HSE’s functions. The Directorate must inform the Minister of any matter which it considers should be brought to the Ministers attention.
The Director General is responsible for the management and control of the business of the HSE. He is answerable to the Directorate. The Director General must attend before Oireachtas Committee. The Director General may delegate his functions to officers within the HSE. Delegated functions may be sub-delegated subject to the directions of the Directorate. Where applicable, operational decisions are delaged to the point of service delivery.
The 2012 legislation amends the arrangements in relation to preparation of service plans. The HSE is to prepare a plan in line with existing criteria and take account of priorities and targets set by the Minister. While the Minister may direct the HSE to amend the plan. The Minister may amend the plan following consultation with the HSE.
The Minister is to consult with the Minister for Children and Youth Affairs. The HSE is to manage health and personal social services provided for in an approved service plan so as to ensure they are delivered in accordance with the plan. The Minister may direct specified measures to be taken in relation to the implementation of the plan.
The HSE is to submit a code of governance to the Minister for approval. It shall set out the roles of the HSE structures and responsibility.
An Audit Committee is established to advise the Director General on financial matters relating to its functions. It is to report at least yearly to the Director General on those matters and on the activities of the Committee in the previous year. A copy of the report is to the sent to the Minister.
The Director General must furnish to the Audit Committee information on any financial matter or procedure necessary to perform its functions when requested to do so. Information relating to contracts, expenditure above a threshold and legal proceedings taken, is to be furnished.
Health (Miscellaneous Provisions) Act 2010 dissolved Saint Luke’s Hospital Boardand transferred its assets to the health service executive. It amended the terms of the Nursing Home Scheme to take account of cases were both members of the couple into a long-term residential care.
The Health Amendment Act 2010 strengthened the basis for the HSE to keep the Minister informed of information required to fulfil the ministers role and function. The provides for a safe channel of communication between the HSE and the Minister.
It places a duty on the Executive to provide information on its own initiative and without delay to the Minister. It gives the Minister power to require (in the public interest) detailed information and documents from the Executive free of legal prohibition and to use such information and documents as necessary for the performance of his or her functions It allows persons appointed by the Minister to undertake reviews etc to similarly use such information
The Executive is to monitor and keep under review occurrences and developments concerning matters relating to its object and functions. It must inform the Minister, without delay, of any occurrence or development that, in the opinion of the Executive, the Minister is likely to consider significant for the performance of his or her functions. In addition, it must similarly inform the Minister of any other occurrence or development that falls within a class of occurrences or developments of public interest or concern that has been specified in writing by the Minister.
The Executive must provide information or documents to the Minister and to ensure that this can be done as
- quickly as possible and without legal difficulties. The Minister can, where he or she considers it
- necessary, in the public interest, for the performance of his or her functions, require the Executive to provide him or her, with any information or documents in its possession or control that he or she specifies.
This must be complied with by the Executive within the period specified by the Minister when requiring the information (and, in any event, without delay).
The provision lifts the existing legal prohibitions which may prevent the provision of the information and documents concerned in areas such as consent requirements, nondisclosure or confidentiality provisions and in camera rules. There is a requirement to satisfy the public interest test which is a further safeguard.
Where the Minister has appointed a person or persons to examine or inquire into a matter and he or she considers the information or documents received are relevant to the examination or inquiry that he or she can release that material to the persons concerned. This will enable them to use the information and documents to prepare a report for the Minister.
The Minister may use information and documents provided as he or she requires for the performance of his or her functions. Nothing in the Act permits publication, in whole or in part, of information or documents received if such publication would not otherwise be lawful. The objective is to have a proportionate response so as to correctly balance the public interest and respect the individual’s legal and Constitutional rights.
The Health Service Executive (HSE) was established under the Health Act 2004 as a new State agency, incorporating the then Health Boards, the Eastern Regional Health Authority and some other health bodies. A Directorate governance structure was put in place for the HSE in 2013. This was always intended as a temporary measure to continue only until HSE functions moved elsewhere under the health reform programme in the Programme for Government 2011-2016.
However, because of the complexities of the health reform programme, the Directorate governance structure has continued for longer than originally planned and a new Board governance structure is therefore now required. In addition, an independent Board for the HSE was also recommended by the Oireachtas Committee on the Future of Healthcare (Sláintecare Report).
The Health Service Executive (Governance) Act 2019 provides for the establishment of a 9 person Board for the HSE. The Board is the governing body for the HSE, with authority to perform the HSE’s functions. The Board will be accountable to the Minister for Health for the performance of its functions.
The Act also provides for a Chief Executive Officer (CEO) for the HSE instead of the current Director General position and for the CEO to be accountable to the Board for the performance of his or her functions. The CEO is not a member of the Board. Other than in the case of the first CEO, the appointment of the CEO will be a matter for the Board.
The first CEO under the new governance structure is person who is the Director General immediately before the repeal of the Health Act 2004 Directorate provisions.
The Board has nine members in total including a deputy chairperson and a chairperson. The Board is the governing body of the HSE with authority, in the name of the HSE, to perform the HSE’s functions and is accountable to the Minister for the performance of its functions. The Board may delegate HSE functions to the CEO and must inform the Minister of any delegations. The Board must also inform the Minister of any matter that it considers requires the Minister’s attention.