Mr. Tony O'Brien:

My apologies. I will take another drink of water. I will begin again.

In response to Senator Crown's question I was referring to the nature of the health system compared to international standards. There are certain characteristics that are atypical. The particular mix we have between public and private provision is probably comparable to that in post-Saddam Iraq. There are not too many comparators with the same blend. The number of acute locations here is rather large by comparison with that in other developed countries with the same population density and overall population size. The number of smaller units here is, therefore, greater than that in comparators, while our largest units are not as big as they often would be in many locations. There is an over-dependence on agency and locum doctors and doctors in training. We have previously talked about this issue at this committee. There are a number of related factors. Some locations experience particular challenges in that regard because, without wishing to be pejorative, they are regarded by prospective job applicants as geographically peripheral, which simply means that they are not located near large urban centres, large universities and so on, even though they may be near very nice parts of the country. Letterkenny is often used as an example, as is the Midlands Regional Hospital.

Senator John Crown asked a question about the nature of the public response. By and large, the vast majority of instances where it is necessary to issue a public comment on issues related to patient care are handled at local level. Where there are significant issues that have a national focus, by and large, the people in charge of services, either regionally or nationally, handle them. Increasingly, community health care organisation, CHO, and hospital group chiefs shape the nature of the message. They will assess the circumstances and what it is acceptable to say without breaching confidentiality and so on and seek to communicate in a way that is faithful to the circumstance. On occasion, that does mean that it is necessary to have some legal input, particularly if there is likely to be a follow-on process that we do not wish to prejudice. If it is a matter that is likely to become an issue for the State Claims Agency, in other words, a legal claim against the State, we have an obligation to liaise with it. By and large, the HSE is not an organisation that has recourse to external public relations expertise. That would happen very rarely. I suspect we are one of the smallest users of external public relations advice in the State sector. I think that is what the Senator is asking me about in respect of external force.

In respect of disciplinary infractions, there is an important discourse about the nature of regulated versus unregulated professions, not just here but also in other jurisdictions. Administrators or managers are not members of professionally regulated professions, which I think is unfortunate. It devalues these professions and is one of the reasons, at a time when training for managers was eliminated from budgets, continuous professional development funding remained available for the regulated professions because it was a statutory requirement. That meant that people did not receive development training at a personal or professional level to enable them to deal with some of the challenges about which we are talking. It also meant that, as people came into these posts as others vacated them, they were not given access to the professional development training one would have wanted them to have. I believe the contribution administrative personnel make to health service delivery is sufficiently important to deserve that protection and regulation.

That said, the experience of other jurisdictions is that while professional regulation and licensing are important, they can never be substitutes for employer based disciplinary processes. All members of staff in all parts of the health service are subject to the disciplinary code, irrespective of whether they are in a regulated profession. That is as it should be.

In regard to the report in today's The Irish Times, members may not be aware that a small amendment was made to the online version of that article. The document at the centre of the report, which I have read, was a follow-up letter to the Minister of the time sent one day after a meeting had taken place with that Minister. The letter made reference to costed ideas prepared in response to concerns about services in the Coombe, Mullingar and Portlaoise. The meeting was part of an overall service planning process involving clinical programmes in respect of which the HSE applied for €22 million in development funding in 2011. On reading the 2012 service plan, I do not see any provision for that investment, which I interpret as meaning the resources available were not sufficient to enable those programmes to proceed. I was not involved in the service planning process at the time, however. The report in The Irish Timesstates that I had been involved in that discussion in the capacity of national director of clinical strategy and programmes. That post was held by a different individual, however. The authors of the letter, in expressing to the Minister how they would like to proceed, mentioned a number of people, including me, as people they would like to work with in implementing the proposed measures. It is true that the letter referenced in the newspaper exists, and I have a copy of it.

I have no knowledge of any threats or legal discussions of any kind relating to the "Prime Time" programme. I asked a colleague to investigate whether anybody else had such knowledge but according to the note that I have received nobody on my team has any knowledge. I am aware that members of the HSE participated in the programme, both in the pre-filmed package and in other ways. It comes as news to me that there was any suggestion of an attempt to interfere with the programme, other than the normal process of providing information, asking questions and agreeing who should take part in interviews.