John Dolan (Independent) | Oireachtas source

I will honour the Chairman's request to ask only one question. As a prelude to that, I want to pick up on some of the things Mr. Devane said. First, however, I wish him the very best. Deputy Kelly said he was sorry for Mr. Devane's troubles but they are troubles that belong to all of us if what the HSE is doing does not work, particularly those of us who need health services. That is the bottom line.

Mr. Devane referred to making clinical governance great. What about social care governance? The HSE must continue to improve health outcomes for the public in the future and give staff space to work with as distinct from just coping with demand. We cannot spend money we do not have.

In reply to a question from Senator Mullen, Mr. Devane stated that charities can set a tone and expectations. Mr. Devane referred to collaboration between the HSE and the voluntary charitable sector and indicated that much can be done there. He also spoke about looking for a mechanism by which to bring more patient voices into consideration. I think I am reflecting what Mr. Devane said fairly decently. He also made some comments following Senator Mullen's contribution about the mental health sectors. There were references to safe service within the budget. When Mr. Devane was talking about the time he spent working for Macmillan Cancer Support, he indicated that the best €1 million it spent was on data and understanding the needs of the patient. There is a whole range of chronic conditions to consider.

This committee had the new chief executive, Mr. Paul Reid, before it two weeks ago. He brought with him the memo he had issued to his staff on 14 June. The simple message was that holding the line on the budget is sacrosanct. We must build up the trust and confidence of our funders, of those who need the services right now and all of us who will need them one day. Everyone needs that assurance.

There are governance quandaries in respect of these things and that is the point to which I am coming. Mr. Devane is not the provider, he is the head of the governance structure that is there to provide the services. I am trying to pick between the two of them and not unnecessarily drag Mr. Devane into questions about what he is doing in respect of this and that. There is a distinction between being provider and commissioner. We had a system, in the early 2000s, in the Eastern Regional Health Authority, ERHA, whereby the commissioners and health boards were the providers. It was thought that was not necessary.

The UN Convention on the Rights of People with Disabilities includes a whole section on mental health and it has now been agreed that this will be implemented by Ireland. There are governance elements to that convention and the political conundrum relates to the interpretation of what is "urgent" and what is "critical". I am not against strong lobbies but our bodies work when and if we have balance between different elements. How is there balance, appreciation and an appropriate weighting between the strong, established, powerful areas and other areas which need advocacy and support? Mr. Devane touched on this when he was talking about mental health but which organisations and groups can be of assistance outside of the health area, where one would prefer to be starting? We need governance that is beyond regulatory compliance.

That is a medley of the issues. How will Mr. Devane, as chairman, and the board manage all of those competing pressures and tensions, and the lack thereof in some places? The edict to hold the budget applies to people with disabilities and chronic illnesses, anyone and everyone. We will wait while one service provider earns the respect of other public bodies. I find that unacceptable.