Mr. Paul Reid:

I thank the Chairman and the Deputy. I will come in behind Mr. Watt on a number of points. I will relay the Deputy’s thanks back to the teams and I thank him for making those comments. They make a difference.

To deal specifically with the general point which the Deputy has made about embracing these issues with the pace and agility that has been demonstrated over the past two years, I share the Deputy’s appetite that we embed that into the future. There are probably three things that I would take from the past two years that we need to consolidate in our ways of working.

The first lesson is a much better understanding of what value is added from the centre of the HSE and what value is added from the services. That is a core principle of Sláintecare. For example, we focused on some of the national issues like the procurement of personal protective equipment, PPE, testing and tracing, and vaccination. We let the services then get on with driving reform because they know best and can do it best on the ground. That is something we have to unleash and embed in a stronger way in the next couple of years. That is one learning.

The second lesson from the past two years relates to decision-making. For far too long, we have taken too long to make decisions on business cases and on PowerPoint. I certainly know, with Mr. Watt, that we are committed to this. We used the principle during the past two years that we will probably get 70% of our decisions right, and I do not just mean from a clinical perspective, but in driving change. We have to learn from the other 30%. What we cannot do is wait for perfection at all times. In the next phase of change we are certainly bringing in the principle that if we are 70% comfortable with something, it is probably good enough to let the system go at it. That is the second principle we want to embed.

The third lesson, which is completely aligned with Sláintecare, pertains to the whole issue of moving services to protect the acute hospital system by increasing the services in our communities. We gave some good examples in our opening statements involving community health networks, community specialist teams, access to diagnostics with GPs, primary care facilities and staffing.

One of my colleagues made a specific comment on CHO 7. He touched on something that is a challenging issue for recruitment. I will give a very brief outline of the scale of this. Over the past two years we have recruited over 35,000 people. We have to recruit 9,500 people every year to stand still as part of the natural churn. We have 132,000 people now in the HSE, which is a net increase of 12,500. As Mr. Watt has said, it is the biggest and most unprecedented increase. On top of that, we have had to add a further 4,000 people who were working on testing and tracing, and vaccination programmes. If one looks at the mix of that, and I will not go through it all here, one will see that for once we have got a very good mix. Across that 12,500 over the past couple of years, some 3,300 have come from the nursing and midwives professions, 2,100 are actual staff nurses and midwives, almost 2,000 are healthcare assistants, 360 are consultants and 2,300 people are working on patient and client care. These are people who are on the front line, perhaps as healthcare assistants or NAS staff. We have difficulties in some areas, which I fully acknowledge to the Deputy, particularly in some of the areas he mentioned like south Kerry and Donegal. It is an issue for us to recruit the specialists we need in those areas. Generally, we are seeing that professional consultants, in particular, want to move to and be based in the big urban centres. There is a quality of life issue that we are trying to promote in our recruitment process and we need to do more work on that.