Alan Kelly (Tipperary, Labour) | Oireachtas source

The witnesses are very welcome. The Chairman is cracking the whip so I will just fire out the questions because we are under time constraints. Do the witnesses believe the group structures within the HSE are working? Could they be improved? Obviously, they are not perfect and if they can be improved, how can that be done? How big an issue is the fact that they do not align with the community structures? It is certainly an issue and we should not fool ourselves that it is not. How big an issue is that for the witnesses in their day to day work? Is the fact that each of the witnesses has different structures as regards boards, management teams, etc., and alignment of hospitals under those headings a major issue for them? Should it be consistent? That is my first set of questions.

With regard to workforce planning, we had a very good presentation on that from somebody here. Recruitment is a huge issue across the board. How is it affecting the witnesses' planning their operations across their hospitals?

Regarding community care, I was very much taken by a number of references, particularly with respect to the mid-west. Would all the witnesses agree that it would make more sense to take a quantity of funding out of the acute space and put it into the community space in order to ensure they do not have the demands they have in the first place coming into the hospitals in which they operate? That came across in the presentation covering the mid-west in particular.

Regarding patient pathways care, what are the issues with moving patients across the witnesses' hospital network post-care, pre-care and so on? What are the real issues in that regard, particularly issues relating to delayed discharges, staffing and transport?

On the use of private hospitals, how will that fit in with regard to helping out the witnesses with their workload? We are facing into winter and in a number of the locations private hospitals are advertising their emergency departments for patients while some of the accident and emergency departments they run are jammers, which is insane.

We have a major issue in Ireland with the provision of doctors, particularly in many rural areas. Every member of this committee knows that. Is there real concern about that in that if it gets worse, demand for their services will increase again over the coming winter period?

That will leave the services in an even worse situation than they were in previously.

I have two final questions. With regard to IT, there is a great deal of different commentary on IT provision. Obviously, it is not up to speed. What do the witnesses consider to be the best developments they have seen over the last year or so in IT provision? It is incredible that in 2016 we are not managing patients and their details in an IT-efficient fashion and still are using old ways to do it.

Finally, have the witnesses any comments or what did they feel personally - this question is particularly directed to the CEOs - in response to the letter from the chief executive of the HSE, Mr. Tony O'Brien, a number of months ago which commented on their performance? How did they react to it? What did they take from it? Did they consider it necessary?