Tommy Broughan (Dublin North East, Independent)
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13. To ask the Minister for Health his plans to enforce greater accountability by management of the Health Service Executive and his Department officials, in view of recent quality issues in hospitals, nursing homes and care homes; and if he will make a statement on the matter. [20541/15]

Leo Varadkar (Dublin West, Fine Gael)
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At my request, the HSE developed and set out a considerably enhanced and strengthened Accountability Framework in its 2015 National Service Plan. The Framework makes explicit the responsibilities of all managers to deliver on the 2015 Service Plan targets across a balanced scorecard covering the four vital areas of:

- Quality and Safety

- Access

- Finance and

- Human Resources.

The Framework describes in detail the means by which the HSE and in particular the Hospital Groups and Community Health Organisations will be accountable in 2015 for performance across these four areas and allows for a level of transparency in the process of accountability which has not been there in the past.

A key feature of the Accountability Framework is the introduction of formal Performance Agreements between the Director General and each National Director and between the National Directors and the newly appointed Hospital Group CEOs and Community Health Organisation Chief Officers.

A set of Key Performance Indicators are in place to assess performance on an ongoing basis. A formal escalation and intervention process has been introduced for under-performing services which includes a range of sanctions for significant or persistent underperformance. The escalation process requires supports, interventions and sanctions to be applied. Sanctions fall to be considered at a later stage if supports and interventions do not lead to sufficiently improved performance. The response to underperformance will be differentiated and includes limitation of autonomy in relation to staffing decisions, close monitoring of remedial actions, restrictions in access to additional development and capital funding and restrictions to participation in non-core activities.

My Department engages with HSE senior management on a monthly basis to review performance across the areas of quality and safety, access, finance and HR and detailed performance information on these areas is published on a monthly basis.

The recent HIQA report on Portlaoise highlighted the need for greater accountability across all levels of the health service. The report raised serious questions and issues relating to the appropriateness and effectiveness of managerial actions. These matters will be addressed through HSE internal disciplinary procedures. The Director General of the HSE has confirmed that two review processes will be set up and will involve external reviewers from outside of the HSE in order to guarantee full independence and transparency. One of these reviews will investigate managerial decision making and risk management issues raised in the HIQA report. It will be open to this review to recommend that the disciplinary procedure commenced in respect of particular staff.

The accountability of officials of my Department is governed by the Public Service Management Act. My Department has recently published its Strategy Statement 2015-2017 which sets out a range of commitments and against which performance will be evaluated over the period.