Mr. Tony O'Brien:

I emphasise there always is a danger, when one has someone who is identified as the director of quality and patient safety, that it could be perceived, either internally or externally, that it is that person. If one looks at every divisional section of the service plan, quality and patient or client safety, as the case may be, are referenced and very clear. Those national directors who are not present today will be at our quarterly meetings - there are too many to bring all at once - but they all accept a focus on patient safety as a fundamental part of their obligations. It is not just saying it but doing it and making it a key part of every decision made, recognising that opportunities to improve arrive from time to time and that there are decisions which, if one goes the wrong way, will have an adverse impact on patient safety.

To turn to the issue of the staff reduction, where we have a say, we will not be facilitating the exit of staff from front-line services, not least because we would need to replace them and would simply be increasing our costs were we to so do. That said, there is a grace period exit programme envisaged in the Haddington Road agreement to August 2014 and we will have no control over who chooses to exit early to avail of enhanced or preserved pension entitlements. We cannot control this, but where there are voluntary schemes, they will be voluntary on our side also. Unlike in the past, while there will be no compulsion on a person to go, a person who volunteers to go will be faced with a manager who will be obliged to volunteer to let him or her go. We will not be seeking to let people go where we need to replace them. In the last year we did not achieve the targeted reduction. In some instances, that was because we would not let people go because patient safety could have been compromised. Consequently, in so far as there is a hierarchy, achieving a reduction in people is not at the top of it because it does not always make sense to so do. We must make calls and take responsibility for them. Notwithstanding the fact that we are required to balance a range of Government policies and priorities, we must and do make calls.

I am deliberately taking the financial control space last because in some respects, it is part of the message we are trying to send. I refer to the Ogden review and the follow-on report I commissioned on becoming the acting or deputy chief executive officer of the HSE, namely, the PA Consulting Group recommendation. Moreover, the financial improvement programme approved by a board which I chaired and which included senior personnel from the HSE and the Departments of Public Expenditure and Reform and Health is now available on the HSE's website. It spells out in absolute detail the manner in which we intend to reshape the financial management model, that is, moving away from an excessive concentration on financial transaction processing to more of an added-value financial management process to ensure funds are properly tracked and used etc. As the Minister stated, the appointment of the chief financial officer is part of that process and I will invite him to say a word. I acknowledge that a specific question has been tabled in this regard for the quarterly meeting and the answers have been supplied in respect of the numbers of staff and so on. However, we seek to reform fundamentally the way we approach financial management in the system. We are, by agreement, developing a business case for a single common chart of accounts, supported by a single financial system, which will apply to the whole of the publicly provided health service. This will, among other things, help us to address some of the issues being addressed by another committee of the Oireachtas because of the visibility it will give us.

In respect of acute services, last year, in the 2013 plan, we carried out a significant rebalancing in respect of additional resources. It is true that the overall cost of providing the acute system has come down considerably. However, at a certain point in time we had reached a stage where the health service was guaranteed to be destabilised by financial overruns in acute services because, put simply, too much had been taken out too quickly, more than anywhere has ever successfully achieved. It was creating a situation where, when I became the deputy chief executive officer of the HSE in August 2012, I was faced with a likely overrun, without significant corrective action, of €500 million. That led us in a highly negative direction in terms of some of the cuts that had to be made and it is to avoid precisely this, that these processes I have described around the figures of €113 million, €108 million and so on are so essential. Without such processes, the level of risk attached to the service plan would have been sufficient that I would not have changed the introduction, to put it in a nut shell.