Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the Minister and his officials and the contribution in which the Minister set out his views. Are the views he expressed consistent with the view of the Department or are they personal? I would like to find out whether there is broader support across the administrative system for the Minister's proposals and the views he expresses.

The Minister referred to hospital groups, community health organisations and geographical compatibility. When he speaks of top-slicing the Health Service Executive and giving more dispersal to hospital groups, the key issue is who will be the future employer of staff. The number of staff employed by the HSE when section 38 organisations are included is substantial, standing at approximately 127,000. Will hospital groups become the employer in future or will staff be retained in a broader, larger national administration?

On hospital groups, when a hospital closure or withdrawal of a hospital service is proposed, often on the basis of clinical evidence, a HIQA report or guidance, politicians very often assume the role of advocating for members of the public. In doing so, they do not necessarily advocate for hospital safety or patient safety. If we are to develop a system, it must be sufficiently robust to withstand this type of influence, while also providing some form of accountability to a specific entity. The democratic process needs to be engaged but this must be done without political interference, which was one of the failings of the health board system.

Does the Minister have a clear view of the geographical competencies of the hospital groups and community health organisations? There is no doubt that decisions must always be based on clinical rather clinicians' reasons because there is a fundamental difference between the former and latter, as was clear in the process by which hospital groupings were proposed and various hospitals linked, which was not necessarily always based on clinical factors but for reasons related to clinicians. We need to be conscious of this issue.

The Minister is correct that clinicians at all levels are frustrated by a lack of access to or say in management, even at ward level. I ask the Minister to elaborate on how he envisages greater clinical input being achieved in the management and delivery of services.