Wednesday 21 March 2018

HSE staff still carrying 'health board baggage' nearly 10 years later

Minister for Health James Reilly. Photo: Tony Gavin
Minister for Health James Reilly. Photo: Tony Gavin

Eilish O'Regan Health Correspondent

TOO many health staff are still wearing their "regional jerseys" and are overly focused on local concerns, a new report has revealed.

Although the HSE will be 10 years old next year, many of its staff are still carrying the baggage of old health boards, which were seen as too parochial.

The HSE was set up in 2005 to end the "parish pump" health board system and instead deliver services more efficiently under one national umbrella.

At the time there was criticism that the health board system led to an overlap of services and they were too inward-looking.

However, the report from the PA Consulting Group said one of the HSE's weaknesses is a low sense of belonging by many staff and this is not just limited to those working in the finance sections.

The report, commissioned by the Department of Health, investigated the financial systems in place following strong criticism by the troika about health overspending.

It comes as the HSE is insisting that all agencies that it funds, particularly those paying top-ups, ensure they have proper financial controls in place.

The consultants report said: "Perhaps the greatest challenge being faced is in changing culture and behaviours across the health system and this is consistent with many change programmes."

It found:

* Financial management is about reporting not control.

* Budget holders are rarely accountable for success or failure in meeting budgets.

* Staff are putting more importance on meeting external requirements - such as reporting to the Revenue Commissioners and Comptroller and Auditor General - than compliance with internal rules and regulations.

* A lack of trust pervades the system including in the financial information available.

The release of the management consultants' report, delivered to the HSE in August, follows recent controversy over the €50m payout by Irish Water on outside consultants.

PA consulting is an international firm with offices in Dublin and Belfast.

The report found that while staff involved in finance in the HSE are insightful, innovative and committed, they are challenged by inconsistent investment in training, in access to technology and a reduction in headcount.

It found just 16pc of the staff involved in finance have qualifications in accountancy, with 11 of the 702 who were surveyed being fully qualified accountants.

It also concluded that the wrong people are in certain jobs in hospitals and there is a policy of filling jobs with candidates from general administration rather than experience and knowledge.


The success of changed financial systems in the HSE relied strongly on having the "right people in the the right roles".

There is a lack of consistency among hospitals in the amount of resources they have allocated to financial management.

"Health services in Ireland face the dual challenge of reducing costs while improving outcomes for patients. In these circumstances the need for strong effective financial management is of paramount importance."

Asked if the recommendations are being implemented, the HSE said: "Following detailed work over the past number of months involving a wide range of health service staff involved in finance-related activity, a new operating model for finance has been designed and agreed."

Irish Independent

Today's news headlines, directly to your inbox every morning.

Editor's Choice

Also in Irish News