Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputy for genuinely acknowledging that the changes we are making are exactly to that end. I am appointing the head of the Department and the head of the HSE to this role. They report to me and I will report in to the Cabinet, so this is being managed at the most senior level, with clear lines of direction and accountability on that.

With regard to the regional health organisations, essentially, what we are talking about is merging community and acute care. That was the point. A lot of work was then done on how that might be achieved and the six regions were arrived at after a long consultation period. Some people agree with those regions and some people do not agree with those regions, and that is quite normal.

A reorganisation of our healthcare system is probably the highest risk element of our reform programme. Tackling the waiting lists, adding capacity, changing the models of care, and increasing advanced nursed practitioners and GP access to diagnostics are important but they do not pose a systemic risk, even if they do not work as well as one might want them to. A reorganisation of a system as complex and critical as our healthcare system is a high-risk endeavour. That is why the Sláintecare report itself said it should be done with minimal change.

If we are going to embark on what I believe is the highest risk part of Sláintecare - it is one of the enablers but it is high risk - it must have the oversight and the leadership from the Government, me, the Department, Mr. Watt and the HSE and Paul Reid. However, if it is going to work, the change has to be owned by the people in the system itself. A mistake would be for a group in the centre to come up with a detailed design and then announce it and say, “This is the new change and this is what is going to happen”. International evidence shows that is resisted by the people who we need to be part of that change. Therefore, while the policy direction will be owned at the most senior level at the centre, if we are going to get this right and do it successfully, it has to involve people right around the system, in the CHOs, hospital groups, hospitals and throughout the system. Essentially, there will be wide consultation and involvement in this process.