Mr. Ciarán Devane:

We want to understand the people strategy, the numbers and the recruitment. We want to make sure we recruit people we can afford, not those we cannot afford, and that we recruit people who we need rather than those we might not need or where there may be another way of doing it. We will ask ourselves if we have the right people strategy for the HSE. There is always a temptation to fix an issue by hiring another body, whereas actually it could be possible to ask an existing staff member to solve that issue. We will ask the executive to outline what our overall people strategy is to make sure we have the right skills, people and pipeline in place because workforce is a major issue in most jurisdictions, the roles are changing so quickly and the specialisms are changing so quickly that it is difficult to even catch up.

I recognise what the Senator is saying about accountability in the example he has given. We have to create an environment where a unit manager feels that he or she owns the whole problem and can make the right decision, that he or she has the support behind him or her and can access the expertise if he or she needs to but does not need 15 other people to meet and discuss it. That is often what patients want. They want someone to take on their issues. People respect that and we have to give our staff the confidence that they will be supported to make the right decisions. This goes back to the issue of learning and safety. Across all health systems, we hear time and again that complaints come in, not because people just want to complain but because they want to be heard, they want someone to listen to them and they want to make the process better for the next person to come through the system. A lot of that comes down to individual accountability and empowerment. Those two go together and then we must support people to make the right decisions. On the odd occasion that something goes wrong, it is not about blame but about learning so that it is less likely to happen the next time. As a cultural intervention, there is something in that.