Mr. Robert Watt:

I thank the Deputy. I agree that context is the first casualty of political debate now, it would seem. The context for all this is critical and everyone knows that the pressures the system has been under for the past while have certainly impacted on our ability to do other things. Since I took over this role only nine months ago, I have spent 90%-plus of my time in regard to policies on Covid, vaccination policy, test and trace, hotel quarantining and all the different aspects the Department has been grappling with. That is the reality of it. We are now hopeful, given where the disease is, that we will be able to focus on all the other non-Covid aspects of health and public health that we have to do.

I will not add too much to what the Minister said on this question of centralisation. The CEO of the HSE has reorganised the centre, and he did that a few months ago. There is an interesting debate about what functions should remain at a central, national level, with national standards, policies, procurement policies, IT, HR and all of that, and what then should be delivered at a local level. I am pretty convinced, having read a lot of the research on this internationally and in Ireland, that we need to align CHOs and hospital groups. We need to integrate them to have organisations at a regional level that can deliver the integration of care that we talk about.

The demographic challenge the country faces, because of the number of people aged over 85 and the number of people over 60, is the wider context for this debate. There is a massive increase in the demand for our services and it is only going to go one direction, thankfully, as our citizens are living longer. As we know, as they live longer, they will have more conditions and they will rely more on the health system. We cannot meet current needs, let alone future needs, with this structure, and we need to have much more of the service provided at primary level and community level. The change that is proposed in regard to the regional health areas, RHAs, is critical to deliver that.

The final element, which is very important, is in terms of the allocation of budgets. We allocate budgets based on "acute", "primary" and so on. We need to start allocating budgets over time on the basis of the population needs of people in particular geographics, so that we look at what are the needs of a population - not what are the needs of the acute system or the community system, but the needs of the population - and allocate on that basis.

They are the critical elements. We need to make decisions over the next few months and the Minister will have to decide, with his Government colleagues, exactly what implementation plan to embrace in regard to the RHAs. We are committed to doing it and the HSE is committed to doing it, and we will push ahead strongly over the period ahead to do it. It is a fundamental reform. I agree, having read once again the implementation report on Sláintecare, that this is a fundamental aspect we have to deliver to achieve the overall objectives.