Dr. Catherine Day:

Behind the day-to-day delivery is the health policy. As the HSE is so big, a lot of responsibility has been delegated to it and until fairly recently it did not even have a board to hold them accountable in some way. We felt there was a little too much distance between the Department and the actual conduct and way the policy is being implemented by the HSE. While there is lots of international practice about delegating work like the HSE does to agencies, experience also shows that in the end, the political responsibility comes back to the Minister and the Department. Given that, we felt that should be a stronger line of communication, including a way to signal problems between the HSE and the Department.