Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I understand the premise of the Senator's question and it is a very fair one. We are tasking the centre with reducing its authority or its executive bandwidth, so whether that is a direct conflict is a very reasonable question. Regardless of whether there is a conflict, when embarking on a programme of reform and organisational redesign of this scale the only people who can lead it are the senior leadership teams in the organisations. They are the only people who can lead. No one else can do that job other than the senior teams in those organisations themselves. If you give it to somebody else it will fail because the organisations will not own it. They will not have created it and they will resist it. There is consistent evidence of that in large-scale change all over the world. It has to be led at the most senior levels politically, which is me reporting to the Cabinet, as well as at an official level, which is Mr. Watt, and at an operational level, which is Mr. Reid. That is the leadership team. Mr. Reid and Mr. Watt are going to co-chair a very senior group of people who will report to me and then I am accountable to the Oireachtas, to this committee and to Cabinet. The first thing needed for success is absolute commitment at the most senior level. Given that, the Senator's question, which is how we ensure that happens, very much comes into play. Part of what we have to do is tap into the fact that everyone involved is dedicating every minute of every day to universal healthcare. Everybody has bought into that. All of us have bought into that. If people have bought into this, the argument has to make sense. If it makes sense, and if people can see that this is better for patients, clinicians and workers, then it will happen.

The concept in management terms is subsidiarity, that is, pushing out decision-making as far from the centre as possible. We have just seen an incredibly successful model of that with the vaccine programme. Right at the centre we had a task force that reported to me, we had very senior leadership from the Department and the HSE and we had a very clear goal, which is critical for these programmes as well. You have to be absolutely clear about where you are going and what it is you are trying to achieve and then the operational model is to push out the local solutions locally. For example, I was in vaccine centres in universities, in GAA clubs, in hotels and in all sorts of facilities. Every single person running those vaccine centres had to optimise locally but with all the support they needed from the centre. Another area that gets less attention but which was even more random is testing and tracing. I went to a testing and tracing centre in an old fire station. We had testing and tracing on the site of a county GAA stadium and in all sorts of different places. Again, that worked because our front-line workers were trusted to do the job that they know how to do and they got the support they needed from the centre. That is essentially the philosophy. I have bought into that, the Department has bought into it and the HSE has bought into it. The Senator's question, which is really important and is one we are going to have to keep asking ourselves repeatedly, is whether we, the HSE or the Department are resisting this concept of subsidiarity. We need to make sure we are not. The way to deal with that is through a very clear goal and everyone passionately wanting to get there. I am also establishing an advisory group specifically on this area so we will have a group of people who are outside of the direct implementation who will be able to feed back into the Department and to me as to whether they think we are getting that right.