Simon Harris (Wicklow, Fine Gael) | Oireachtas source

In response to Deputy Kelleher, I always thought the Department's and the Minister's views were supposed to align and that I was supposed to set the policy and the Department was supposed to implement it. I assure him my speech reflects that. Deputy Alan Kelly would remember how it is meant to work. Obviously, I have worked with the Department in developing my views on this since I took office but, in fairness, much of that builds on the thinking of the Department of Health over a number of years. We must be honest with each other. Often it has been the political system, and I blame myself and my party for this as much as I blame anybody else, that has failed to deliver on the long-term policy proposals that are generated by the system. In fact, many of the challenges that the HSE and others face, which I outlined in my speech, are challenges that have been imposed by the Houses of the Oireachtas, rather than by any unnamed bureaucrat or civil servant. These are my views, but I wish to get to a situation whereby the committee's views become the view of all parties in the House so that they will provide ten year certainty in terms of the direction of travel. That has been lacking to date.

In terms of the employer, the Deputy asked a very important question. Two models could be considered, and I am interested in the committee's view on the way we should go. One could have stand-alone employments for the hospital and community health organisations whereby they would employ their own staff. The other model, and perhaps the more sensible way, is that one could have people employed as members of the overall health service and then assigned to the various group structures - which one is preferable would have to be teased out.

With regard to geographical locations, I am always a little nervous about politicians drawing lines on maps as I am not sure that we are best placed to do that. I am not sure that we need the current number of hospital groups and I certainly do not believe we need the current number of CHOs. This is a small country. For a start, the CHOs and the hospital groups definitely need to align. That is my priority. What the geographical boundaries are is something on which I am happy to accept expert opinion and views and, indeed, local views through clinicians, hospitals, hospital groups and so forth.

The Deputy is right to highlight the difference between a clinical reason and a clinician's reason. There is a big difference. If hospital groups, or whatever we wish to call them, are to work, that will involve a consultant or other doctors being assigned to more than one hospital. It will involve somebody living in a more remote or rural area having a consultant from one of the larger hospitals visiting their hospital to provide the appropriate services to be delivered in that hospital. The Deputy is right to differentiate.

We agree on the clinical voice in management. This has got lost somewhere along the line over the last decade. The Deputy and I meet the doctors as we go about our business. They are really frustrated. We hear them in the media. They basically feel that short of approaching the Deputy or me or going to the media, they cannot get their viewpoint across. That should be a cause of alarm for all of us. The clinical directorship was an idea to try to address that but I am not sure it has been fully empowered in the way I would like it to be. We should reflect on that. The three maternity hospitals in Dublin are all run by clinicians. I believe they are doing very well. It proves that clinicians can also lead the management team. That does not mean that every clinician must be a manager or every manager must be a clinician, but it is a viable option that should not be seen as the exception to the rule.

Regarding what the national agency will resemble, I would appreciate the Deputy's views on that. My view is that we do not wish to lose all that is good about the national agency. It is easy for people to come here and slag off the HSE, point fingers or to be politically partisan about it. It achieved some good things in terms of national standards and programmes. Would the cancer control programme have been put in place without the HSE? Of course not. Those political and national decisions were taken. In my view, standards, care pathways, commissioning and budgeting rest with an agency. The daily operations and strategic planning for parts of this country should be devolved to a more local structure.

I agree with Deputy Naughton on the voice of the clinician and I have tried to address that. I understand the Deputy's concerns regarding the capacity review. Indeed, Deputy Kelleher and others have made those points to me as well.

We do not want the HSE and the Department to simply decide on a given number of beds and then take the view that the box is ticked. We have tried to get the balance right with the international group and expert oversight. However, I believe it is important for the Department to have a sense of ownership of the document. In the past the Department has commissioned work only for it to become another report from another management agency. There is a question of balance and we will endeavour to get that right.

The comments on the realigning of the community health care organisations and hospital groups were dead right. We all visit hospitals. We have all witnessed the hospital manager expressing complete and utter frustration when a patient is ready to go home but the manager cannot get him or her home to the community. This is because the manager does not have in his possession the levers to try to get the patient into the community. The manager has to go to an entirely new management structure, the community health care organisation structure.

We talk about an integrated approach to health care but we have two silo approaches. For example, let us suppose Mrs. Murphy goes to hospital today. She goes in through the hospital group structure. Then let us suppose Mrs. Murphy needs to come back out today and she needs home care, an aid or appliance, nursing home care or access to the community and social care structure. It is not at one and I do not believe we can stand over it, certainly not as part of a ten year plan.

I brought along to the meeting a picture that was sent to me when I became Minister for Health. It is of Bevan, the founder of the HSE. When he was setting it up, Bevan said that illness is neither-----