Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I welcome our guests and thank them for appearing before us. I wish Mr. Devane well in the job that lies ahead. It is a challenging job at a challenging time.

I have been critical of the performance of the HSE since it was first instituted. That criticism was warranted, as we have not had a seamless and smooth system of delivery of services to patients, who are the people who matter. Notwithstanding that, we have the fourth or fifth highest level of expenditure on health among OECD countries. We need to reach a point of being able to ensure value for money, effectiveness and efficiency in our service. Sláintecare will do that, provided that we can achieve it.

Previously, my concern was that the HSE was remote from some of the institutions over which it had control in terms of the delivery of services. Similarly, many HSE staff throughout the regions and at its centre were unsure about where they were supposed to be going, what they were supposed to do, who their bosses were, at what stage they should use their initiative and at what stage it might be dangerous to use their initiative. I have been concerned about this from the beginning. I used to be a member of a health board, and the health boards were the opposite in that regard. They were abolished because politicians were involved. That was a woefully wrong decision. Events have since proven that my conclusion was correct. The exclusion of politicians took away from the institutions of the health services the support that came from local politicians and the responsibility that was forced on same by being in a position of authority. There were two sides to the story. There is an issue for the board to deal with in that regard.

There is now a single board for the whole country. I still have my doubts about that. The extent to which the board can extend its remit to the furthest extreme of the HSE's institutions and realm will be very important. That has not happened in the past. I asked the board's first chief executive whether he believed that the proposed structure was the appropriate method of delivering health services to a population the size of Ireland's, having regard to its geography rather than to the situation obtaining in the greater Manchester area, which was the comparison at the time.

We will all give Mr. Devane the support he deserves in trying to do a job that has been very challenging in recent times. Everyone blames everyone else. That is the problem, but it is the nature of the game. We have a responsibility. If we are spending a great deal more money comparatively speaking than many of our colleagues across Europe, we must be able to say that we are at least on par with their average. We cannot be behind. That is the challenge and I wish Mr. Devane well in it. As far as we all are concerned, we will do our best to help.