The Health Service Executive (HSE) was established on January 1st, 2005, taking over the running of the health service from 11 regional health boards. Some €12 billion is spent annually on health and there is a total staff of 100,000.
A unified administration was meant to reduce costs and increase efficiency, putting an end to the duplication of management positions and inconsistencies in the services provided.
However, under an agreement reached with the Impact trade union, former managers who were not appointed to senior positions in the new structures retained their salaries and conditions while new managers also received the higher pay scales. Responding to criticisms of rising salary costs last week, HSE chief executive Prof Brendan Drumm said this deal was reached with the Government before he took up office.
In fact, the delay in appointing a chief executive - Prof Drumm only took up the job last August - also led to uncertainty and a delay in change being implemented. The health boards continued to run services in their regions until June as a transitionary arrangement.
Prof Drumm, who left a post of consultant paediatrician at Our Lady's Hospital for Sick Children in Crumlin, Dublin is paid a salary of €320,000 and recently received a bonus of €32,000.
The role of the Department of Health differs from that of the HSE in that the department is supposed to be concerned with policy formation, while the HSE's role is to implement policy. However, there has been criticism that this distinction has not been clear enough.
A major criticism of the new system from Opposition politicians is that it allows Minister for Health Mary Harney to refer criticisms of the health services to Prof Drumm and the HSE.
Questions posed in the Dáil, which in the past would have been dealt with by the Department of Health, are now referred to the HSE, and TDs complain that it can take a long time to get replies.