The HSE and local accountability


Sir, – I fully support Minister for Health Leo Varadkar’s assertion that the HSE needs to be replaced with local governance structures (“Varadkar reveals plans to replace HSE with more local structures”, December 15th).

As I approach the last couple of weeks of my seven-year term as master of the Rotunda, one of the things that I have learned over this period of time is that good clinical governance should be local.

It should be absolutely clear when you walk in to any hospital or health institution who is responsible and where accountability lies for the provision of the service.

It has been very clear over the past number of years through a variety of incidents and reports that having governance structures at a distance from the local service does not work. Structures need to be put in place at a local level to ensure that there are appropriate key performance indicators and reporting within the local hospital.

However it is absolutely vital that when issues of concern arise that there needs to be a well-recognised path for escalating appropriately to the funding authority to allow for these issues to be addressed.

The current governance structures concentrate more on financial management and balancing budgets than clinical outcomes.

The sooner we move to a situation where there are clear lines of reporting and clear accountability within our hospitals, such as happens in the Dublin maternity hospitals, the sooner we will have a much better health service. – Yours, etc,



Rotunda Hospital,

Parnell Square,

Dublin 1.