HSE Organisation
Establishment
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. The body was established as an independent corporate body.
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 that were dissolved in so far as they are related to the planning, delivery, and operation of health and personal social services.
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 Board’s 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 the Health (Corporate Bodies) Act, 1961 and transfer their assets and responsibilities to the Executive. References in existing legislation to the previous bodies are to be referred to the Executive where appropriate.
Health (Miscellaneous Provisions) Act 2010Â Â dissolved Saint Luke’s Hospital Board and transferred its assets to the Health Service Executive.
HSE Functions
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 the authority to commission and take part in 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 its 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 health authorities have the power to acquire land for the purpose of providing their services. Lands may be acquired compulsorily. There are procedures in relation to the compulsory acquisition of land by health authorities for health purposes. See the separate sections in relation to compulsory acquisition processes.
Governance
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, or advisors.
The Executive may appoint employees and determine their functions and duties subject to conditions. The Executive must prepare a superannuation scheme for approval by the Minister for Finance.
2013 Governance
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.
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 the government had committed to the eventual dissolution of the HSE as part of the 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 governing authority was 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 Directors.
There is no fixed number of Directors, but there is a maximum of seven and a 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 the 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 minister’s 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 the 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 delegated to the point of service delivery.
2019 Board
However, because of the complexities of the health reform programme, the Directorate governance structure continued for longer than originally planned, and a new Board governance structure was 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.
Ministerial Directions & Priorities
The Minister is empowered to give general directions to the HSE under the Act and to give specific directions on the submission of reports and information by the HSE in relation to its function. Ministerial directions may be given in relation to the implementation of government policy and objectives where the Minister believes that the HSE does not have sufficient regard for 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 practices 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 that relate to the Minister for Children and Youth Affairs’ functions.
Reporting to Minister
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 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.
The Health Amendment Act 2010 strengthened the basis for the HSE to keep the Minister informed of information required to fulfil the Minister’s role and function. This provides 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 use such information similarly.
Minister Enquiry
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 to be relevant to the examination or inquiry, 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.
Finance
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 be sent to the Minister.
The Director General must furnish the Audit Committee with information on any financial matter or procedure necessary to perform its functions when requested to do so. Information relating to contracts, expenditures above a threshold and legal proceedings taken are to be furnished.