HIQA has encountered recent challenges in implementing escalation measures due to the health service’s new regional structure, according to its CEO Ms Angela Fitzgerald.
Ms Fitzgerald made the comment in a letter to HSE CEO Mr Bernard Gloster on 29 May 2025. The correspondence was obtained by the Medical Independent (MI) through Freedom of Information law.
In her letter, Ms Fitzgerald acknowledged Mr Gloster’s “prompt response” to her correspondence in terms of facilitating constructive engagement between HIQA and the HSE on recent changes to health service structures and reporting lines.
“Such engagements have included a standing invitation for HIQA to attend the REO [Regional Executive Officer] forum meeting on a quarterly basis,” according to the letter.
“These meetings have enabled a better understanding for the new REOs of the regulatory requirements of the Chief Inspector and in relation to healthcare monitoring. Specifically, we have sought to share with your new team the escalation requirements as specified in the Health Act 2007 and to agree how we will give effect to our regulatory function, including such escalations, under the new structural arrangements within the HSE.”
In this context, Ms Fitzgerald wrote that HIQA also welcomed the recent meeting with the HSE Chief Technology Transformation Office – alongside counterparts in the Mental Health Commission – to enable better understanding of the evolving regional structures and reporting arrangements within the HSE.
“Notwithstanding the constructive engagements, as you know, we have experienced some challenges in a small number of circumstances where escalation measures were required, particularly in relation to the use of the provisions of Section 64 of the Act,” stated the HIQA CEO.
Section 64 of the Health Act 2007, as amended, allows for the provision of care arrangements when HIQA cancels the registration of a designated centre.
Ms Fitzgerald thanked Mr Gloster for his “direct intervention” in these cases. “To address such matters going forward, we have developed a draft communication and risk escalation protocol in conjunction with the REO forum, which we are keen to finalise with you.”
She added this recent experience “also underlines the importance of continued engagement between us to support the bedding down of the structures and the smooth implementation of our regulatory functions under the Act”.
The letter referenced proposals to re-establish formal governance meetings between HIQA and the HSE, which were in operation for a number of years before ceasing in 2023.
Ms Fitzgerald stated there was “significant benefit in such regular planned engagements”.
A HIQA spokesperson told MI it was agreed with the HSE CEO in December 2024 that the governance meetings would be reinstated. A schedule of meetings is being arranged, the spokesperson added.
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