Former members of the disbanded HSE board have said the operation of a multibillion euro healthcare body without appropriate board oversight was unacceptable.
As the Government prepares for its reinstatement, previous members have said while it was hard to speculate how the cervical cancer controversy might have played out under their watch, the removal of such governance had been a mistake.
"Could you show me a single larger organisation that doesn't have a board?" former member Prof Niamh Brennan said.
“I would say that almost every organisation in the country needs to have a board. [It is] just absolute corporate governance 101.”
Former health minister Dr James Reilly moved to force the resignation of the board in April, 2011, saying a move from that structure would ensure services were run in a more effective manner with less duplication.
Scandal
However, in the wake of the cervical cancer scandal, the Government has given approval for the drafting of legislation to have it replaced, seven years later.
Some of its prior appointees have said they believed progress had been made during their time, particularly in harmonising the old regional health boards into one overall national structure and, with that, the development of successful national programmes.
Those who spoke to The Irish Times put forward a uniform view that a board was essential, while stopping short of speculating on how differently things might have played out in the recent controversy.
Prof Brennan, a chartered accountant who chaired the HSE audit committee and who now sits on the board of the Children's Hospital Group, said progress was being made by those occupying roles "not for the faint hearted". However, she said, it was "remarkable" the organisation had gone for so long without a board in place.
One of her then colleagues, requesting anonymity, said if the cervical screening issue had of been brought before them, they would likely have insisted on the women involved being told at an earlier stage.
“Would that have been brought to the attention of the board? I don’t know,” the person said.
“Given how it has played out I would like to think it would have been but I don’t think you can assume it.
“It seems to be that there was a conscious decision not to inform people. And if you weren’t going to inform the women involved I don’t know if you would inform the board.”
No justification
The former member pointed out that the HSE has now been without a board for as long as it had one and that “there is no justification” for this.
“If the HSE is to continue then in my view there should be an independent board.”
Another former member, also requesting anonymity, said the cervical cancer issue was “the kind of thing that you would expect to be on a board’s agenda”.
“When you have removed the absolute last resort level of governance and corporate oversight . . . you have removed a really significant level of accountability and oversight.”
“It is implicit”, the person added, that had the board been told, the women in question would have been informed.
As for the appeal a newly established board position might hold: “I think you would have to look really hard at what the remit would be, its mandate, accountability and what powers it would have. Until you see that, it would be impossible to speculate.
“There has to be a board. You can’t have a national health system with that level of money at play which also . . . handles people’s mortality which is the highest duty you can have, without a board.”
