{"id":10334,"date":"2022-07-08T17:39:10","date_gmt":"2022-07-08T17:39:10","guid":{"rendered":"http:\/\/legalblog.ie\/hse-established\/"},"modified":"2024-02-25T09:30:24","modified_gmt":"2024-02-25T09:30:24","slug":"hse-established","status":"publish","type":"post","link":"https:\/\/legalblog.ie\/hse-established\/","title":{"rendered":"HSE Established"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_63 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title \" >Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/legalblog.ie\/hse-established\/#The_Health_Boards\" title=\"The Health Boards\">The Health Boards<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/legalblog.ie\/hse-established\/#1983_Commision_on_Funding\" title=\"1983 Commision on Funding\">1983 Commision on Funding<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/legalblog.ie\/hse-established\/#Pre-HSE_Steps\" title=\"Pre-HSE Steps\">Pre-HSE Steps<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/legalblog.ie\/hse-established\/#Prospectus_Brennan_Reports\" title=\"Prospectus &amp; Brennan Reports\">Prospectus &amp; Brennan Reports<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/legalblog.ie\/hse-established\/#HSE_Established\" title=\"HSE Established\">HSE Established<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/legalblog.ie\/hse-established\/#Initial_HSE_Structure\" title=\"Initial HSE Structure\">Initial HSE Structure<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/legalblog.ie\/hse-established\/#Wider_Reform\" title=\"Wider Reform\">Wider Reform<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/legalblog.ie\/hse-established\/#Original_Organisation\" title=\"Original Organisation\">Original Organisation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/legalblog.ie\/hse-established\/#Service_Delivery\" title=\"Service Delivery\">Service Delivery<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/legalblog.ie\/hse-established\/#Further_Changes\" title=\"Further Changes\">Further Changes<\/a><\/li><\/ul><\/nav><\/div>\n<h3><span class=\"ez-toc-section\" id=\"The_Health_Boards\"><\/span>The Health Boards<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The Health Act 1970 established the eight Health Boards.\u00a0 They were responsible for the provision of health care in their area.\u00a0 They comprise local councillors, nominees of the Minister and representatives of health professional organizations.<\/p>\n<p>The 1970 legislation made the Hospitals Council the central body responsible for the organization and development of hospitals.\u00a0 The Hospitals Council was responsible for certain appointments in all hospitals, both health boards and voluntary hospitals.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"1983_Commision_on_Funding\"><\/span>1983 Commision on Funding<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The role of the Health Boards was reviewed in the 1983 report of the Commission on Health Funding.\u00a0 It is highlighted that many of the voluntary agencies funded by the Department of Health are not under the auspices of the Health Boards.\u00a0 Voluntary hospitals accounted for over half of acute hospital services.\u00a0 In addition, several voluntary organisations provide services to persons with disability.<\/p>\n<p>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.<\/p>\n<p>They recommended the establishment of a Health Service Executive authority. The reaction to the Commission\u2019s report was largely negative.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Pre-HSE_Steps\"><\/span>Pre-HSE Steps<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>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.<\/p>\n<p>The Eastern Regional Health Authority was established in 2000.\u00a0 The Eastern Health Board was replaced by three area Health Boards.\u00a0 It became responsible for all health and social services.\u00a0 In Dublin Kildare and Wicklow. Aall voluntary hospitals and agencies came under the auspices of the ERHA.<\/p>\n<p>The Eastern Regional Health Authority replaced the Eastern Health Board in the Dublin, Kildare and Wicklow areas.\u00a0 This was replaced by the Health Service Executive.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Prospectus_Brennan_Reports\"><\/span>Prospectus &amp; Brennan Reports<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The 2001 Health Strategy proposed a review of structures, which was undertaken by consultants in consultation with the Department.\u00a0 The so-called Prospectus Report, the audit of structures and functions in the health service, was published in 2003.<\/p>\n<p>It recommended changes to existing structures, which hindered a standardised approach due to variations in the organisational structures and practices of the Health Board. \u00a0It proposed the abolition of the Health Boards and the establishment of the Health Service Executive as a single national manager or entity.<\/p>\n<p>The Report on the Commission on Financial Management and Control Systems in the Health Service (The Brennan Report) was published in 2003.\u00a0 It recommended the establishment of an executive at the national level to manage the health services but recommended retention of the Health Board\u2019s structure to safeguard local democratic input.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"HSE_Established\"><\/span>HSE Established<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>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.<\/p>\n<p>The Health Service Executive took over the functions of the existing health authorities, the Health Boards.<\/p>\n<p>The Health Services Executive is responsible for the operation of the health service.\u00a0The Department of Health is responsible for policy and the strategic development of the healthcare system.\u00a0 The Minister of Health appoints the board of the Health Service Executive.\u00a0 The board appoints the chief executive.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Initial_HSE_Structure\"><\/span>Initial HSE Structure<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The HSE comprised two principal Directorates, namely the National Hospitals Office and the Primary Community and Continuing Care Directorate.\u00a0 The National Hospital Office was responsible for the allocation of resources, service delivery and performance management of the 50 public and voluntary hospitals.\u00a0 There were 10 hospital network managers through whom it acts, which correspond to the former Health Boards.<\/p>\n<p>The PCCC directorate was responsible for health and personal social services at the community level through 32 local offices.\u00a0 The administrative areas for Directorates and other functions are divided into four principal regions; Dublin Midland Leinster, Dublin North East, South and West.<\/p>\n<p>In each of the four areas, a Health Forum comprising elected representatives was established under the Health Act 2004.\u00a0 Each City and County Council within the region returned representatives based on population.\u00a0 The Forums make representations on a variety of health and personal social services in the region.\u00a0 They have no formal executive role.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Wider_Reform\"><\/span>Wider Reform<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The establishment of the Health Service Executive was part of a wider reform of health services.\u00a0 The Health Information and Quality Authority was established.\u00a0 New frameworks were established for governance, planning and reporting.<\/p>\n<p>The establishment of the Health Service Executive was intended to be the first step in a five-year program of transformation of health services.\u00a0 It contemplated a single service comprising doctors, hospitals and community care.<\/p>\n<p>The Health Service Executive is responsible for health, personal and social services.\u00a0 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.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Original_Organisation\"><\/span>Original Organisation<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>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.<\/p>\n<p>There were three principal National Directorates. The National Hospitals Office deals with public hospitals and ambulance services.\u00a0 It covers all acute hospitals. The Primary, Community and Continuing Care Directorate deals with community care.\u00a0 The Population Health Directorate is responsible for strategic planning for the HSE, including health service delivery, health promotion, and protection.<\/p>\n<p>The HSE is divided into a number of administrative areas.\u00a0 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 \u00a0Louth, Meath, Cavan and Monaghan.<\/p>\n<p>HSE West is responsible for Connaught \u00a0Limerick, Clare, and North Tipperary.\u00a0 HSE South is responsible for South Tipperary, Carlow, Kilkenny, Waterford, Wexford, Cork and Kerry.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Service_Delivery\"><\/span>Service Delivery<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Services may be delivered directly or through voluntary hospitals, private providers, GPs and voluntary organisations.\u00a0Community health care and personal social services embrace a range of nursing services, including home health, social work, and occupational therapy.<\/p>\n<p>The HSE areas must provide service plans and budgets.\u00a0 They are assembled into a national service plan.\u00a0 The Department of Health sets national priorities, which are to be reflected in the plans.<\/p>\n<p>There are a number of health forums to allow public participation, consultation and feedback.\u00a0 There is a national forum and a regional health forum.\u00a0 Members of the national forum include representatives of management, service providers, professional bodies, patient groups and others.<\/p>\n<p>The regional forums allow local consultation and feedback on local issues of concern.\u00a0 Members are nominated by Councils. \u00a0The forums make representations to the HSE on issues relevant to the area.<\/p>\n<p>Having centralized health care management through the establishment of the HSE proposals existed as of 2008 to devolve powers and administration to regional directorates.\u00a0 Each was proposed to have responsibility for healthcare in its locality. It was proposed to merge the NHO and PCCC directorates.<\/p>\n<p>Health spending accounts for approximately one-quarter of total public spending. In 2009, over 130,000 people were employed in health services.<\/p>\n<p>There are numerous agencies and bodies within the health services which have been established by law.\u00a0 These include various boards and councils providing a range of services.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Further_Changes\"><\/span>Further Changes<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>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.\u00a0 The HSE appointed four regional directors to manage services within the four regions based on nationally set priorities and parameters.<\/p>\n<p>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.<\/p>\n<!--themify_builder_content-->\n<div id=\"themify_builder_content-10334\" data-postid=\"10334\" class=\"themify_builder_content themify_builder_content-10334 themify_builder tf_clear\">\n    <\/div>\n<!--\/themify_builder_content-->\n","protected":false},"excerpt":{"rendered":"<p>The Health Boards The Health Act 1970 established the eight Health Boards.\u00a0 They were responsible for the provision of health care in their area.\u00a0 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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[176],"tags":[],"_links":{"self":[{"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/posts\/10334"}],"collection":[{"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/comments?post=10334"}],"version-history":[{"count":4,"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/posts\/10334\/revisions"}],"predecessor-version":[{"id":32253,"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/posts\/10334\/revisions\/32253"}],"wp:attachment":[{"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/media?parent=10334"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/categories?post=10334"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/legalblog.ie\/wp-json\/wp\/v2\/tags?post=10334"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}