Leo Varadkar says HSE is massive and needs to be slimmed down

Cabinet meeting to discuss proposals including review of HSE management systems

Taoiseach Leo Varadkar has said the Health Service Executive is a massive organisation that needs to be slimmed down.

“It’s almost too big to manage,” he told RTÉ News when interviewed as he arrived at Government Buildings on Tuesday morning.

There is a need for people who can act as a check between the executive and the Government making sure that policies are implemented and that the organisation is held to account, he said.

There is also a need for “a different sort of board, it’s going to be smaller, it will have an executive chair – it’s not just going to be somebody or a group of people who turn up for a meeting once a month, they’ll have much greater involvement.


“But also what’s fundamentally different, and this is very much in line with the Sláinte care recommendations. It isn’t going to be just one board for this massive organisation - that’s too big to fail and too big to succeed.

Massive entity

“The HSE is such a massive entity, a budget of €16 billion, 110,000 people. It’s almost too big to manage, it needs to be slimmed down and this new board will be the board for the slimmed down national sector and it’ll have much more local and regionally accountability, so this is very much in line with what the Government has been doing for the last number of years.”

When asked about the HSE’s role in the CervicalCheck controversy, Mr Varadkar said: “The decision to hold back information, not to give women full information was pretty much devolved down the line.

“One of the things that really bothers me about this is that the HSE decided at a middle level that there should be full disclosure, but then passed it down the line to individual doctors to make that decision for themselves and you can see at different points where they say ‘in line with hospital policy where appropriate’ and I don’t think that’s right.

“I think if there is a national policy that national policy should be followed from top to bottom, but it’s not good enough for the people at the top or the middle just to say that. They have to follow it through.”

Minister for Health Simon Harris will seek approval on Tuesday from colleagues to restore the HSE board and to conduct a review of the current management system within the body to assess if it is fit for purpose.


The board will also be asked to develop an effective performance management and accountability system within the HSE.

Under the proposed legislation to be considered by Cabinet, the board will be accountable to the Minister for the performance of its functions.

It will also be responsible for the appointment of a chief executive, who will be responsible to the board for the performance of his or her functions.

As part of its first tasks, members will be asked to prioritise a full examination by the new director general of the current senior management in the HSE – structure, responsibilities, capacity, skills and experience.

The Cabinet will also on Tuesday consider a proposed strategic “national centre” tasked with carrying out national level functions, and with new regional bodies accountable for implementing integrated care.

The proposals follow weeks of controversy over the CervicalCheck controversy and the failure to inform women of the results of a clinical review into their cases.