The former chief executive of the Health Service Executive, Cathal Magee, asked the organisation's internal audit unit last year to investigate whether some health service reforms put in place by Minister for Health James Reilly were impacting on governance and control arrangements in place at the time.
A report carried out by HSE internal audit and published yesterday said some operations of the special delivery unit (SDU) in the Department of Health – which was set up by the Minister – and the establishment of two hospital groups in Limerick and Galway had generated concerns and tensions among some health service managers.
It said some developments in the health service between September 2011 and March 2012 “had the potential to dilute HSE’s governance and control framework”.
Internal audit
The audit report reveals that in January 2012 Mr Magee established a group to report to him on governance issues that had occurred since September 2011 relating to the HSE. It said subsequently he had asked HSE internal audit to review governance arrangements and controls.
It said that in the period concerned issues that had the potential to impact on the HSE’s control environment included the establishment of the SDU, the establishment of new hospital groups in Limerick and Galway as well as the establishment of new interim health services.
'Blurred lines'
The report said direct contact by the SDU with hospitals and the provision of additional funding by it to hospitals without notifying HSE managers who had responsibility for managing the organisation's service level agreements with these hospitals "could result in blurred lines of accountability and potentially could undermine HSE's ability to manage the service level agreements and manage the financial and employment control elements of these agreements."
It said that at the time of the review there was a perceived lack of clarity about accountability, authority and the reporting relationships of the SDU and the HSE.
It also said that various HSE managers had said the SDU had not kept the authority informed of its actions at all times or in a timely manner and that “this impacted on HSE management’s ability to manage the HSE budgetary and employment processes with hospitals”.