James Reilly (Dublin North, Fine Gael) | Oireachtas source

As a consequence of that report, there was a further report. We now have in place Mr. Thomas Byrne, the chief financial officer. Within his remit, he has a complete reform board for financial reform within the HSE. We know there are 11 systems from the old health boards. Equally, we know there are literally hundreds of IT systems throughout the health service. Somebody mentioned a figure of 1,700 and some of the systems are not able to talk to one another. New ones are being developed and there are problems with their ability to deal with what needs to be put in place. I will allow Mr. Byrne to talk about that issue in a more complete fashion.

There is a sense among certain people that acute services drain all of the resources from everywhere else. That is not absolutely true by any means. The two areas with the greatest deficit - in nearly equal amounts – are demand-led and one concerns acute hospitals. If somebody presents who is acutely ill, it is not like the airline industry in that we cannot refuse to take off because the aeroplane is not safe; we have to look after the person or he or she will die. Equally, the PCRS is often in serious deficit because it is also demand-led. If people are entitled to and need a medical card, they must have it. There is no doubt that further efficiencies can and will be achieved, but they take time. Much of the low-hanging fruit has gone. I refer to the new ways of delivering care, the new models of care and the areas I have addressed before at the committee, including the questions of why we have nine nurses per health care assistant in some model four university-type hospitals and 2.8 nurses per health care assistant in others and why we have 2.5 health care assistants per nurse in some community nursing home units, while we can only manage a ratio of 1:1 in others. There has been a difficulty in achieving best practice across the system. We are now achieving this through the special delivery unit in the HSE and particularly through the clinical programmes which have carried out extraordinary work in many places. An example is the care of stroke sufferers. The survival rate from stroke has shot up as a consequence of the clinical programmes. The same applies to the programmes dealing with congestive heart failure and frail elderly persons. More needs to be done and, as I mentioned, the single assessment tool must be borne in mind.

Deputy Sandra McLellan asked what would occur if the target of €108 million was not achieved. I will allow Mr. O'Brien to address that issue, but in my view the answer is very simple. The Department of Public Expenditure and Reform, the Department of the Taoiseach and the Department of Health, with the HSE, are examining how the target may be achieved. If it transpires that it is not achievable, it will become a matter for the Government to revisit. That is the straight, simple fact of the matter.

With regard to children, there is a new model of assessment and intervention in making progress on disability services for children and young people. Some €4 million has been put aside for that purpose and 80 whole-time equivalents. The area of children's mental health services is a source of grave concern. Historically, it tended to fall between stools. In north Dublin, for instance, there was a considerable deficit in the services to provide for those between the ages of 16 and 18 years when the legal age of a child was raised from 16 to 18 years. A question arose as to where those in this category belonged in terms of the provision of services.

All those issues are being ironed out. There is still much work to be done but I believe we have come a long way. Perhaps Mr. O'Brien would address specifically Deputy Regina Doherty's questions.