Former Ryanair Executive Critiques HSE’s Slow Cost-Cutting Measures

A board member of the Health Service Executive (HSE), formerly the deputy chief executive of Ryanair, has publicly criticized the slow implementation of cost-cutting measures he proposed. In correspondence with HSE chief executive Bernard Gloster, Michael Cawley expressed concerns that there was a lack of urgency in adopting strategies aimed at reducing expenses within the health service.

In an email exchange released under Freedom of Information legislation, Cawley noted that the Government should be informed that certain savings targets were unlikely to be achieved. In January 2025, he submitted a list of 14 recommendations intended to save money for the health service by the year’s end. By April, Cawley conveyed disappointment over the minimal progress, stating that achieving a reduction in spending—including cuts to administrative costs—was “neither achievable nor realistic.”

Cawley acknowledged the HSE’s efforts to contain costs but emphasized that “much more remains to be done.” His recommendations included implementing technology solutions for home care, limiting the spending authority of certain management positions, and addressing high IT maintenance costs. He also highlighted issues such as over-prescribing of medications and the surplus of specific drugs. Furthermore, he proposed that private companies utilize hospital equipment and operating theatres during off-peak hours.

Despite his suggestions, Cawley pointed out that eight of the fourteen recommendations had not been addressed. He urged for closer monitoring of expenses related to travel, subsistence, postage, and training. During a recent audit meeting, he noted that initiatives from the HSE’s finance department were unlikely to deliver the expected savings.

“If this attitude and approach don’t change, I propose that we inform the department that we are abandoning this objective as it makes no sense to continue with the pretense that we are serious about it,” Cawley stated.

In response, Gloster defended his record on addressing cost-related issues, asserting that he had clearly communicated which of Cawley’s suggestions were feasible at this time. He acknowledged that 2025 would be a “daunting” year for the health service, with some changes likely to take time to yield results. “I share frustration at the time and pace of some change,” Gloster commented, adding that while there have been advancements in pay control, concerns remain regarding non-pay expenses.

Cawley responded by emphasizing the need for a shift in “commitment, energy, and imagination” from the HSE’s senior leadership team. He expressed doubt that the measures initiated thus far would meet the set targets or what he believes is achievable.

A spokeswoman for the HSE noted that it is the responsibility of board members to scrutinize and question the work of the executive team, and that the executive team welcomes this kind of feedback.