Mr. Tony O'Brien:

I was appointed to this role. Rather, I was invited to take up the role on the basis of a set of Government policies which were about the abolition of the HSE and the introduction of universal health insurance. So I did the job in a particular way, in the context of that, for close to three years, expecting to be winding down the organisation and moving it into a collection of different types of service providers, hospital groups on a statutory basis and community health organisations. As the Deputy knows, that did not happen. I had discussions with the relevant Ministers. What we have actually been doing is seeking to prepare the HSE for the type of future envisaged in the Sláintecare report as a result of which Government sanctioned: the appointment of a chief operations officer so that there is very clear accountability for the operating system; the appointment of a strategy and planning head in order that we have much more focus on planning to population need, as they do in other countries; and, just recently, for the first time ever in the Irish healthcare system, the appointment of a chief clinical officer. So what I have been attempting to do in the second three years, and it has been extraordinarily slow because of the approvals processes one must go through, is come to a much more streamlined system of governance. That is the only reason people have moved around in this context. In an organisation the size of the HSE, people move around. They have opportunities to apply for different jobs, posts become vacant and other people come in. Yes, it is complicated. An organisation the scale of the HSE is inherently complex. I have long maintained that the structures of the HSE are in fact not fit for purpose. I have been saying that throughout my time. I have now got to a point where I think, subject to the implementation plan for Sláintecare, that there is a much coherent organisation of functions at the top level which is useful and valid. It is extraordinary that, for the very first time, the Irish health system has a chief clinical officer - appointed within the past four or five weeks. I am very glad to have been the one who brought that about.