Mr. David Hughes:

On the question of budgets, we have a situation where public health nursing has moved away from being able to assess needs and then order and deliver aids for people fairly promptly. That function now requires an elaborate business case to be made for everything, which delays the delivery of service. Sometimes one does not get an answer or the process can take months. Unfortunately, the person who needs the aid will have moved to another place or will be gone altogether before the aid can be delivered. Direct heads of service are now unable to command their budgets thus delaying and, in many cases, preventing patient care. The matter must be given great consideration. We have gone from a fairly direct management reporting structure to a very indirect one.

Communities have gone from a very accountable system, where local regional health authorities serviced by elected members at least could ask questions about the service being provided, to a situation where nobody can ask any questions. Managers only answer to managers. There is a terrible lack of governance and that has led to a situation where the heads of the service have little or no control over whether they can replace the staff or supply what the person needs. That also happens in hospitals. There is a pushing back, particularly of nurse leaders, in terms of budgetary control and ability to deliver services. That is what has happened.