Ms Anne O'Connor:

I thank Deputy Shortall for her comments. They mean a lot to me. In this room, the Deputy goes back further with me in my career than probably anybody else.

In terms of culture, the Deputy is correct. There are a couple of issues in terms of teams. Part of our challenge is that we are growing services in all different care groups. We are competing and there is an internal competition taking place between mental health, disability, primary care, etc. When we look at that in the round, there is something about specialisation in terms of what a population needs. We have a very professional health service compared with many other countries. We have many highly trained and skilled staff, which is great. We need those people but we have to ask ourselves what we are doing about the lower end in terms of the whole population piece. The Deputy will know this from Sláintecare. Our challenges and the bit we have to focus on is getting that lower level right. We need the specialist end but if we are not doing the lower level right, it is all for nothing at the other end because we will just keep trying to plough people into a much tighter end of the pyramid.

From our perspective, in trying to retain the staff we have has to be about local ownership in terms of staff identifying with their local unit. Our staff surveys show that people identify with their team or ward. They do not identify with the HSE if they are working in a team in Ballymun or whatever. We have to enable that centrally. The regional health areas, RHAs, will bring us back to that with more focus on the local unit, local identification and empowering people to work for their local populations. It is that sense of ownership and control that encourages people to stay and the retention is huge. Between the pandemic and everything else, that has got a bit lost. Hopefully, with the development of enhanced community care, ECC, we will get back to that.