HSE set-up was like a ‘high speed car crash’, says O’Brien

Planning for new reforms will be ‘more sophisticated’, says health chief

Head of the HSE Tony O’Brien said the way it was established a decade ago was “like a high speed car crash”. Photograph: Alan Betson

Head of the HSE Tony O’Brien said the way it was established a decade ago was “like a high speed car crash”. Photograph: Alan Betson


The head of the Health Service Executive has said the way it was established a decade ago was “like a high speed car crash”.

Tony O’Brien, in an interview with The Irish Times , said the organisation had come into existence at a time when the groundwork for its set-up had not been done and when it was not ready.

He said this meant the “high-speed amalgamation of the health boards in 2004, which resulted in the HSE when it was established to replace them having a very difficult initial period”.

“It did not have its first substantive CEO for eight months and a lot of things arise from that which I think, personally, actually sowed the seeds for the substantial problems the HSE has experienced in doing its job in the intervening period,” he said.

However, Mr O’Brien has promised that planning for healthcare reforms that are to be introduced shortly will be more sophisticated and of a higher calibre.

The Government’s new healthcare reform programme essentially involves dissolving the existing HSE and putting in place a number of new structures leading ultimately to the introduction of a system of universal health insurance, hospital groups and trusts and the establishment of a Patient Safety Agency.

Mr O’Brien said the Government had agreed timescales for the new health service structures to replace the HSE which allowed for the various elements to be set out sequentially and implemented in an incremental manner.

He said the HSE’s service plan for this year pulled together a lot of the key changes that need to occur.

A national pricing office had been established on an administrative basis within the HSE and it was pushing forward with the mechanics to allow the roll-out of the concept of “money follows the patient”.

He said the HSE was involved in the process of recruiting chief executives for the new groups of hospitals while the Minister was appointing the boards to oversee them.

Mr O’Brien also said the HSE was examining, in great detail, the appropriate structures for community healthcare.

Furthermore, he said preparation was underway for the establishment, initially on an administrative basis and fairly quickly afterwards on an independent basis, of a patient safety agency. He said this would have a primary advocacy role of helping patients access services in what could be a complex system.

Mr O’Brien maintained that the current process of reform was of a higher calibre than that which led to the creation of the HSE in the first place.

“When bringing together disparate statutory bodies you need to do things; you need a clear inclusive culture, you need to demonstrate through your structures your focus is on patients and clients and therefore on services.

“There was no cohesive culture developed for the health service or the HSE.”

Mr O’Brien said that as part of the initial management structures, those with responsibility for services were out-numbered at the top table by those with responsibility for back office functions.