Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

This is probably the most important element of the legislation. Deputy Cullinane referred earlier to our experience in this committee with the south Kerry CAMHS issue. At that meeting, we were trying to get to the point where we could identify who was in charge and who was responsible. It was impossible to do that because there was no clear chain of command at all. There were various different management bodies. There was the administrative one within the CHO, but then each of the different disciplines have their own management structure and they report up through that, whether it is physiotherapy, public health nurses or whatever. The RHAs will assist in devolving power and responsibility down through the service.

The existing management structure is completely dysfunctional even within each of the CHOs. The Minister made the point about having a single budget and that it makes sense as it means we do not have delayed discharges because there is no money for home care. All of that is very important but equally important is having a clear chain of command and a management structure so that when something does go wrong, the buck stops with identifiable people. When the Minister quotes section 49, he refers to how a health service provider that may have committed an offence can end up being fined and so on but what is a health service provider? The HSE is a health service provider but there is no point in fining the HSE. It must be tied into legal accountability for named posts within the management structure. This is what concerns me. I have made this point a few times when problems have arisen within the HSE. You get the sense that everybody is responsible and yet nobody is responsible. I think the term "health service provider" is a very wide and ambiguous one. It does not fill me with confidence that there will be a way of identifying whether that the buck stops with "X" be that at a clinical or administrative level. This is what we need to do. If people are employed on very high salaries, responsibility must come with that. This is the only way. There must be consequences for individuals concerned when the job is not done properly or responsibly. The fact that it is still quite loose concerns me.