Michael Harty (Clare, Independent) | Oireachtas source

I wish to address the topic of governance in the HSE. There are serious governance malfunctions and, in many areas, an absence of good governance in the health service in general. The OECD has found that Ireland has one of the highest spends on health services, yet it has some of the worst outcomes when it comes to accident and emergency treatment times, delayed admissions - with patients left waiting on trolleys - waiting lists for consultations and waiting lists for planned elective admissions. The latter was starkly illustrated two weeks ago by the delay identified in scoliosis surgery for children. Many other patients suffer in silence.

There is lack of clarity in the governance structures between the Minister, the HSE and the Department of Health. The HSE board has been abolished but the HSE continues to operate, seemingly at arm's length from and independent of the Department. There is no certainty in the HSE and its future existence is unclear. The HSE was set up to centralise decision-making and to have consistency in the delivery of services throughout the country. This has failed because our services are as fragmented as ever. Many HSE officials work in an interim or acting capacity and are unclear about their roles and functions. This leads to a lack of trust and undermines any governance consistency. It leads to a lack of trust by patients and by front-line staff.

Hospital groups have been created but most do not have fully functioning boards. It is unclear whether they will become trusts. Community health organisations do not coincide with hospital groups in geographic settings, thus blurring areas of responsibility. The interaction of individual hospitals within groups is poorly defined and model 2 hospitals can be starved of funds and resources while services in larger hospitals are given priority. Hospital services and primary care services seem to work from different budgets and there is no integration. This poor governance leads to substantial inefficiencies in the system and accounts for poor value for money, as identified by the OECD, and leads to much poorer outcomes for patients.

Poor governance decision-making costs money but there is no transparency or accountability in the governance structures of the HSE to account for inefficient spending. Cost-benefit assessment applies to the provision of drugs such as Orkambi and Respreeza, but no such cost-benefit analysis applies to governance decisions. If we demand clinical excellence, we should also demand governance excellence.

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