Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I am aware of that. I am not talking about the actual charge. I am talking about stretch income targets, the target versus the figure. There is a difference. Mr. Mulvany knows that. There is a difference between collecting all the money which HSE is obliged to do, and that is separate, but setting a target for the amount of money causes a problem with regard to how the HSE is going to plan, as a bizarre incentive is imposed on public servants to impose a target on other public servants to collect money out of the private sector. If those stretch income targets are still in place, I would be worried because it is not a prudent way to plan and because of various other reasons that I will not go into here. If Mr. Mulvany is saying the targets have not changed in the past two years, I can only assume they include the stretch income targets. We reviewed this less than a year ago and the stretch income targets were included. If the HSE is aiming to hit a figure of savings and it is massively wide of the mark, which it is, and it is counting in the stretch income targets in that figure, that brings me back to the point that the witnesses have not been able to provide an explanation as to where that figure came from, which is worrying. If stretch income targets are part of it, is it not time that the HSE acknowledged that it is not working and that it should try to figure out another way to proceed?

Various initiatives took place a number of years ago and Professor Drumm was one person who initiated them. They included having a conversation with staff. We spent a long number of days in Government Buildings where we were given the use of a room and health service workers came in and talked about the way on-the-ground savings could be achieved. It was around the time the moratorium on recruitment was imposed. Much of what we heard were simple changes and how the staff envisaged such simple changes could be made. I am not talking about the big issues, such as the out-of-control agency staff bill, but some changes that could be achieved at the level of the ward or the primary care centre. Suggestions were made by staff but they were not followed up on.

That might be something the HSE would consider ensuring is followed up in the context of a plan. If, say, a staff nurse in Letterkenny General Hospital has an idea for the way she would improve the running of a ward, that might not be a feasible consideration as we would all have the idea that if more staff were brought in, we would not have to deal with constant crises, but if she or, say, a porter in Tallaght Hospital has a worthwhile idea, how could they realistically feed that into the organisation and how would it be taken on board? The top-down approach was tried and, with respect, failed. Perhaps Mr. Mulvany would reflect on that and consult the representative organisations as many people have good ideas. The target is quite ambitious. Mr. Mulvany has just admitted that and he might need all hands to the pump. The organisation has missed it for this year but there is always next year.