Mr. Liam Woods:

I will answer Senator Colm Burke's questions first. The notion raised with us and with which I substantially agree is that there is a fair amount of movement in hospital management. It is clearly evidenced in management literature that stable leadership is a key component of progressing anything organisationally. There is no question that the Senator's contention that one needs stable management over a long time is important. It is also true that there has been quite a degree of movement. I think the Senator is asking if we have looked at that or where the HSE going with that. On the HR side, we have looked at age cohorts. On the management and administration level, particularly in more senior grades, as many people left in or since 2010, there has been a lot of movement relating to the exit arrangements in place at that time and since by way of the age pyramid operating in management and administration in the HSE. The director general has been leading out on this directly. We recently put in, with HR doing the detailed work, a leadership academy, in effect, within the HSE, to consistently develop leadership. In the NHS, there is a Nye Bevan institute, which is designed for that purpose, to develop consistent leadership approaches which build the right value sets and good experience with operational management and process management, with a strong focus on care and compassion. That happened last year and this year and is important for the future. Some of these posts are promotional. One may find somebody moving from a smaller hospital to a larger hospital because of a promotion or because it is closer to home. My broad experience of working in the acute system is that people broadly seek to return to where they come from, which can also cause movement. It affects our clinical recruitment and I accept that it is a big issue.

I accept the point that admission through an emergency department to a ward without the admitting team or consultant knowing should not happen. On the designation of the patient as private as additional to that, I accept that would be a concern for the consultant because he or she may be over-reported as doing private work or have private work happen to him or her. There is evidence, when I look at our national level data and try to compare it locally, of cases where people come in and are recorded as private but are then not billed as private because they have indicated that they do not wish to be. I am surprised about the admissions issue and we would be happy to follow it up but people should be coming under the care of the admitting team. The elective surgery in private-----