Mr. Tony O'Brien:

Let us be completely open and honest with each other. The last seven years have seen a number of people elevated into managerial positions for which they did not receive training or support in order to fill gaps as people left on the various exit programmes. That is fact 1.

Fact 2 is that there are many thousands fewer people operating in the health service than there were before. People may feel over-stretched and they may not have the skills necessary to respond to issues as they arise. We have been addressing that in the last while by supported training, management development and in bringing eminent speakers to speak to a cross-section of the leadership of the health service about this very issue of culture – culture being defined very simply as what we do around here. We have a rebuilding job to do. We are fortunate that with the beginnings of the economic recovery, some of the particular challenges the health sector has had to face because of the necessary reduction in staff numbers and in resources means that we no longer have to ask our manager to focus disproportionately on one part of the balance score card, that being the financial process, which has been the lens through which the health service has been judged for far too long.

Deputy Regina Doherty correctly referenced – I am very conscious of the support that she gave at the time – the emphasis that has been placed in this year’s service plan and in previous service plans on communicating internally to our organisation that the balance must switch decisively towards a greater and balanced focus on other things. Clearly, we have much more work to do. I say these things not in any sense to excuse anything, because that is not the business I am in, but to tell the committee honestly as I started out, the business of changing a culture is a long-term process. I think we all know that. The whistleblowing element of it, and the ability of people to respond in a constructive as opposed to a defensive way to complaints is something that takes time. I hope the emphasis on whistleblowing is a relatively short-term measure. I hope that we can get to a position where there is less and less requirement to have recourse to whistleblowing and more and more confidence in using the normal process of complaint and improvement. That is where I was going with those comments and observations.

Nobody who runs any large, complex system, be it a health system or any other, with services in more than 3,000 locations and deploying more than 140,000 staff directly and indirectly through agencies would ever, with any degree of credibility, come into any forum and say he could give complete assurance that everybody is doing what they should do when they should do it and in the way they should do it. I am not going to do that. It is easy for me to say doing so would be complete rubbish. That is why we are going through the processes to put in place a series of measures designed to take shorter, medium and longer-term steps that can bring us to a place of much greater assurance.