In addition to moving to a single health service executive, the Government has also endorsed the need for improvements in governance in many aspects of the system. Recommendations in this regard were designed to support the adoption of a whole health system approach to decision making at both national and local levels. The critique of current arrangements in this context highlighted a number of concerns, including the potential for tensions between local area concerns, regional interests and national policy objectives and the absence of effective mechanisms for resolving such tensions taking a whole health system perspective; competition between representatives on boards based on locality or professional background rather than objective need; decision making which is not always based on best practice or evidence; and a tendency to focus on operational and short-term issues over strategic issues.