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

I thank Mr. Watt. When the Sláintecare implementation office was stood down, everybody's fear was that we would end up with departmental capture of Sláintecare, and it is clear that is exactly what has happened. There are no grounds for anybody to think things are going to be done any way differently as a result of this. It is just more of the same from the HSE. The problem with the HSE, in terms of a delivery model, is that it is top heavy. It is highly centralised and there is a lack of accountability throughout the health service. There is no line of sight of the massive budgets the HSE gets every year and there is a sense of a black hole within the organisation. What we wanted was a leaner centre, with power, decision-making and accountability devolved to the regions, but what we are getting is a more centralised organisation. At the moment, there is a certain degree of independence for the hospitals and the hospital groups, or for the voluntary ones at least, but if they are to be combined and integrated with the community services, does that mean the HSE centre will now have even wider responsibility and greater control? That is the way I foresee it working.

In case we ever needed an example of what does not work in terms of the centralised nature of the HSE, it is to be found in HR, as anyone working within the health service will attest. It is impossible to recruit a nurse or a doctor because there is this big rigmarole whereby a business case has to be made to the centre, where it is considered, gets lost and comes back down at some point. This is simply not going to work. In light of the fact we did not have the business case and of the fact there is clearly serious concern about our guests' direction of travel, will they give a commitment that they will come back before the committee, after the Easter break, for another session in order that we can properly discuss this? We cannot let this go the way it is going. It is failing the people.