Mr. Ciarán Devane:

I thank the Deputy for his questions. There is something around communicating the vision of the future, the picture of a high-performing, place-based and integrated care model HSE of the future, and giving staff the space to move from here to there. Previously, there have been great visions but everyone has been running so fast just to cope with day-to-day work that they never get fulfilled. A part of the issue is ensuring that, if we want to address an issue, we have the structures and approaches that provide people with the time and resources to think their way to the future as opposed to just leaving it as a picture of the future with no path to it. Sometimes, health organisations are almost too efficient. Everyone is running around the hamster wheel so quickly just to cope with the peaks in demand that there is no space to move. People, in particular health professionals, are motivated when they can see how improvement is happening and they are not just coping with day-to-day work. If we can help with that, it will form part of the work.

I am into integrated, place-based healthcare so that the link between community and acute in terms of public health, physical health and mental health is tight. The real improvements will not take place in performing a unit operation slightly better. It is great if a unit performs a surgery a little better, but the real benefit for the future will be in terms of how the community links to acute, how we ensure that mental health services are involved at the right time and how the support package is delivered. That is how we get into the prevention and integrated side. The thinking behind community health organisations, CHOs, regional integrated care organisations, RICOs, and hospital groups rather than individual hospitals is directionally correct.

As to whether I see the board having budgetary responsibility, the answer is "Yes". We must provide the best possible healthcare for the money available. We cannot spend money that we do not have. Getting to that kind of financial predictability would allow us to, for example, tell people that we wanted to implement the next tranche of Sláintecare and that they could trust us in our budget estimates, since our budget had come in where we said it would. That is a place that we are not at currently but that we must reach. How else can we reassure people that we will land a very complex system on a postage stamp if we have not already demonstrated something like that?