The HSE Performance and Accountability Framework makes explicit the responsibilities of health service managers in relation to the four equally important domains of Access to Services, Quality and Safety of those Services, delivery within the Financial Resources available and effectively harnessing the efforts of the Workforce. The Framework ensures that designated managers are explicitly and personally accountable for managing the performance of services within their allocated budget. Accountable officers are named for each Hospital Group, for each Community Health Organisation, for the National Ambulance Service, for the Primary Care Reimbursement Service, and for the Nursing Home Support Scheme.
Key features of the Accountability Framework are the formal Performance Agreements which are in place at two levels. The first level is the National Director Performance Agreement between the Director General and each National Director. The second level is between the Hospital Group CEO's and the National Director of Acute Hospitals and between the Community Health Organisation Chief Officer's and the National Directors for community services. National Directors are accountable for the delivery of their Divisional component of the National Service Plan and this is reflected in each Performance Agreement. The HSE has allocated maximum expenditure levels to Accountable Officers and they are now fully responsible and accountable for managing the performance of services and resources including staffing levels within their allocated budget. Accountable Officers are required to prepare a financial plan in line with their Performance Agreement with the National Director setting out the actions they will take to meet the agreed performance targets within the financial allocation. This is required to be signed off by both the Accountable Officer and their senior manager.
In the context of the Performance and Accountability Framework underperformance includes performance that places patients or service users at risk, fails to meet the required standards for that service or departs from what is considered normal practice. It is important to note that accountability encompasses performance in the areas of service access, quality, finance and human resources and evaluation of performance. Managers are expected to lead the improvement of performance across all dimensions. Flexibility regarding the utilisation of resources exists within the agreed expenditure levels. The Performance and Accountability Framework provides for the HSE to closely monitor the delivery of services in accordance with the agreed targets and within the agreed financial allocation and for the HSE to take appropriate steps in terms of support and/or intervention as and when the need arises.
