Mr. Paul Reid:

I have a few comments on accountability for now and as we move to new organisational structures. We know in the HSE that we need to strengthen accountability. This is usually raised when things go wrong. We know we have weaknesses in this area. I have brought several papers to our board over the past couple of years. Right now, we are engaged in working through these matters. This will feed into the new structures.

In very simple terms, there are a few strands to trying to strengthen accountability. The first involves having clearly defined organisational roles and responsibilities. There should be no vagueness regarding who is responsible for what. The second involves the very clear delegation of responsibility in legislation, with people accountable in this regard. The third involves the regulation. These are all strands that we are working on. Many of the professional grades in the health system are regulated but some are not, which means strengthening these.

Two issues arise over performance management. The first is that we are not strong enough in performance management in the current system, which means our performance management will have to be strengthened. The second concerns discipline. Discipline involves a very complicated process within the health service. It is quite dated, in some cases dating back to 1970s legislation. These are strands that we regard as being part of accountability, for now and for the framework. Simply putting in six RHAs on their own will not suffice. That is a process we are involved in right now.