The relationship between the Department and the HSE is set out in the Health Act 2004 (as amended). Under the Act, the HSE Directorate is accountable to the Minister for the performance of its functions and those of the Executive, and the Director General is accountable to the Minister on behalf of the Directorate for the performance by the Directorate of its functions and those of the Executive.
The legislation requires the HSE to have in place a Code of Governance setting out the principles and practices applicable to the Executive as a public body. The HSE reports on its compliance with the Code of Governance in its Annual Report and Financial Statements. The Statement of Internal Control included in the Annual Report reports the HSE’s adherence to the requirements in the Department of Public Expenditure and Reform’s Code of Practice for Governance of State Bodies. The HSE also reports annually to the Department in this regard. The HSE’s most recent Annual Report (2018) is available on the HSE website at https://www.hse.ie/eng/services/publications/corporate/hse-annual-report-and-financial-statements-2018.pdf.
The Department oversees the performance of the HSE in relation to the delivery of the services set out in its National Service Plan. In this context, the Department holds the HSE to account for the delivery of high quality services across the four equally important domains of:
i. access to services,
ii. the quality and safety of those services,
iii. doing this within the financial resources available and
iv. effectively harnessing the efforts of the workforce.
This is achieved through an on-going monthly performance management process where the HSE reports against the targets set out in the Service Plan. Monthly high-level meetings between management in both organisations are held to discuss on-going or emerging performance issues and to determine actions to resolve and improve areas of concern. There is also regular engagement between HSE and departmental officials on a wide range of issues to ensure compliance with policy objectives.
The oversight arrangements will be adapted in line with the Health Service Executive (Governance) Act 2019 which has recently been signed into law by the President. Under the new legislation, the HSE Board will be the governing body of the HSE and will be accountable to the Minister for the performance of its functions and the CEO will be accountable to the Board.
A Board governance structure, with strong competencies across key areas, will be a key component in strengthening HSE governance and will contribute to strengthening the oversight and performance of the HSE.
Immediate priority issues for the Board include:
- developing and implementing an effective performance management and accountability system in the HSE
- developing a plan for building public trust and confidence in the HSE and wider health service.
- ensuring the HSE’s full support for and implementation of the Government’s programme of health reform as set out in the Sláintecare Implementation Strategy.