Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

It comes under health and well-being. My apologies, I cannot say which subhead it comes under. I must give the Deputy an Alice in Wonderland answer. Once upon a time, when I was a senior house officer in St. James's Hospital, I used to get a pay cheque from what was known as the Western Area Heath Board, an entity that no longer existed at that time. Similarly, the regions referred to here no longer exist. We have moved away from regions to hospital groups, as Deputy Ó Caoláin noted, and community health care organisations, CHOs. A range of national services are also in place, including the national cancer control programme and the health and well-being programme, under which BreastCheck would fall. As such, accounting continues be based on regions that no longer exist.

Beneath it, the health boards still exist on a financial basis. While we have national services such as the National Ambulance Service, for payroll purposes the ancient health boards still exist. A major financial reform is required in the health system to align how the accounts work with how the service is configured. This is a big job that must be done over the coming years and it requires a big IT investment.

There is no logical basis for funding across regions. It will happen for the hospitals with activity-based funding. Generally, people in health are funded on a historical basis. They receive the allocation they received the previous year, plus or minus an certain amount. This is not the way to do it. Hospitals will move to activity-based funding whereby they will be paid for the work they do and the procedures they carry out. Similarly, for the community health organisations there will be an assessment of population need. Beyond this are the national programmes. The HSE Dublin north east region includes the Mater hospital, which could be providing cardiology and cardiothoracic services to the entire country. It also includes Beaumont Hospital, which could provide neurosurgery for the entire country, other than Cork.

It will never be straightforward. Although the old legacy regions no longer exist, they are still used for accountancy purposes, and it has not changed much. Even after the HSE was established ten or 11 years ago, the health boards were never abolished. It is Byzantine, and will take more than the months remaining to me as Minister to sort it out. It is very hard to justify spending tens of millions of euro on new financial systems and be told one is wasting money on IT systems and accountants when one should be spending it on front-line services. However, if we do not start spending some money on those areas, we will never really be able to implement the "money follows the patient" model.