Colette Kelleher (Independent) | Oireachtas source

The local health forums suggested in my submission are a way into that. As well as the commissioners, which are the HSE, and citizens, one has the organisations that are concerned or involved. They could be advocacy or service delivery organisations and sometimes they are both. The Cork city homeless forum was a brilliant example of that in the noughties. The HSE, Cork City Council and the organisations sat around the table and planned very coherent services. One group was missing, namely, homeless people, and that would need to be corrected. By 2011, there were enough beds for everybody sleeping rough in the city so the forum was very effective. It was not on a statutory basis so it could come and go.

Those kinds of planning forums involve people working together at a local level. The Carlow-Kilkenny model is good, except that one does not find the patients or the charities in there working together. Each has different roles to play and everything does not have to be done by professionals, as sometimes a volunteer can be involved. If someone is living in a residential setting and fancies going to a match on a Sunday, he or she does not need someone with a nursing qualification to do that. It involves those kinds of groups working together, while being driven by the person and citizen rather than the vested interest of, for example, the charity that has always done this work in this way or the professional who must leave a shift at 8 p.m. so everybody has to go to bed at 7 p.m. It is about turning the planning and delivery of services on its head so that it is focused on what the person needs.

All the different actors need to play their part. If charities serve the citizen in advocacy or in providing services, support or volunteerism, they have a role to play and if they do not, they do not have a role. The restrictive practices piece does not just relate to charities. It relates to shift working and working in different ways so that it meets the needs of the person. It is not just about the "stuck-ness" of the system we have. Practices cut across the different interest groups. The professions and charities are in there with their stake but those stakes have to serve the person. There is a unique opportunity to turn things on their head.

The service-level agreements mentioned by Deputy O'Reilly are very rigid and restrictive. There is no doubt that, most of the time, organisations with them deliver more than they are paid to do. There also is an opportunity to look at those in terms of expecting good governance and public accountability from the charities. I am interested in the debate about the national maternity hospital and the arguments between two different groups. Service-level agreements are ways those groups could be forced into because at the end of the day, it is for the State. However, the State often underfunds those agreements.

Regardless of whether it involves a provider, a commissioner or a person working on the front line, unless empathy is at the heart of all this and we do what we do kindly and properly and do not get disassociated from the person at the centre of all of this, none of it matters. That point was very well made by Deputy Buckley.