Michael Harty (Clare, Independent) | Oireachtas source

On the question of whether change should come from the top down or the bottom up, if one takes a bird's eye view of the health service, hospital groups are organising hospital structures and how the structures work but the patients are out in the community and only come into hospital for a short period and they go back out into the community. Organising hospital groups is great for hospitals but it does not actually deliver care to everybody because most people are out in the community.

It was mentioned that in Kilkenny, there is a bottom-up approach in which the integrated care committees, comprised of people on the front line, deliver a service and stream patients into the hospital group in a structured way. Rather than people coming into hospital in an unstructured way, when local groups are in place the patients are streamed into hospital in a structured way. I would like to hear the witness's views on top-down versus the bottom up.

If the witness were a member of this committee, what would be the three game changers she would recommend?