Mr. Liam Woods:

The present governance arrangement is that there are hospital groups within which the 19 units are spread across the country. The intention in the strategy, which has just commenced in the south-south west group, is to put in place networks with clinical leadership that are specifically focused on services for women and infants, in accordance with the strategy. The first appointment in that area has been in the south-south west region where an obstetrician has been appointed to such a role. It is intended that there will be similar networks in the other six adult services and that work is currently under way.

I will come to the mastership piece in a moment. The governance within the HSE moving forward, based on the strategy, is that there are groups and specific networks within groups. There is also a national office, which Mr. McGrane is leading, that is doing both planning and resourcing, as well as evaluation and standard setting, to support those four networks.

There was a further point concerning the role of hospitals and the place of obstetrics and gynaecology services within hospitals. There is nothing in the strategy which intends to put in place a different governance arrangement for those services outside that which is group and hospital-based. Strong leadership is being invested within those. It is akin to taking the clinical leadership dimensions of the mastership role and embedding that in a network leadership role within the groups.

The mastership structure has a history dating back as far as 1720 in Dublin and has served both the city and the country well. I do not intend any critique of the mastership system, but the governance arrangement that is in place here is about having strong clinical and managerial leadership. On the point about ring-fencing and identifying resources, I agree entirely that the programme needs to be able to ring-fence the resource that is within the service at the widest level, support investment from there and avoid any risk of resource seepage into other services. That issue works across a number of specialties. All specialties want to have a ring-fenced resource.

The HSE has already invested in the identification of resource, and activity associated with resource, under the activity-based funding process. It helps us to identify what the resource is in each of those sites and the associated activity in each of those sites that is subject to that dialogue. We would see a leadership model where one has a group, a clinical network within a group, and that network is supporting all the sites. All, bar one group, have multiple sites.