Mick Barry (Cork North Central, Anti-Austerity Alliance) | Oireachtas source

I have three questions. Before putting them, it has been interesting to listen to the witnesses. I note the points that have been strongly made about elder care. My first question is about morale. I am picking up different threads from what has been said. Mr. Liam Doran mentioned the issue of low pay. Another issue mentioned by Mr. Eamonn Donnelly is the lack of buy-in when people do not know what is coming next. Restructuring fatigue and the staffing issue were also mentioned. Can the witnesses pull that together a little? The morale issue arises repeatedly among health service workers. Is it due to staffing levels, pay and confusion about the direction being taken? What is the balance between them and are there other factors? Perhaps the witnesses could put the jigsaw together in that regard with their knowledge and expertise.

My second point relates to a couple of interesting statements in the INMO document.

This relates to an interesting issue that has not been raised here previously. The document states that integrated care requires a simplified organisational structure which clearly indicates responsibility for service delivery and that this can only be done by devolving responsibility, for the provision of all care, to the front line. It also refers to a fully integrated service, within a flat management structure, with responsibility, with autonomy, devolved to clinical front line managers who can access all services for the patient-client. The issue posed here is that of management and control in the day-to-day delivery of the health service. Some of the points in that submission remind me of what we use to see in documentation in the 1970s about workers' control of services and industry and so on, but leaving the ideological aspect of it to one side, in a practical pragmatic sense, can the witnesses give us a flavour of how they think devolving control and responsibility down to the grassroots, to those at the front line of the health service, would make it better? Could they give me some examples of that? I would be interested to hear their comments on that.

I heard the points that were made about a one-tier health service not being based on an ability to pay. The big question is how do we get from A to B. I listened to the points made about where the taxpayers' money goes and where it does not go and good points were made. I presume, but I would like it clarified, that the witnesses would support the idea of a health service which, effectively, would be free at the point of use, something like the NHS in Britain. That is not fully spelled out but it is strongly implicit in the document. I would like the witnesses to clarify that this is the position.