Professor Malcolm MacLachlan:

I will respond to the medical practitioner suggestion.

We are evidence-based and driven by best practices internationally. All the research around what teams work most effectively clearly demonstrates that we should have competency-based leadership rather than leadership based around a particular profession. The area of disability has struggled because of a history of the medical model. There are some good things about the medical model. Medical interventions can be health-promoting or life-saving and they can be crucial to help people not be in pain. That is the good element of the medical approach. The bad element is the history of institutionalisation of people with disabilities and over-medication. For instance, half of the people in this country who have an intellectual disability and who are on antipsychotic medication have no psychotic symptoms at all. There are continuing problems with that model. That is the good and the bad. The ugly bit of the model is in the hierarchical approaches to decision-making. There is a myriad of research indicating that where there are more democratic processes, with different members of multidisciplinary teams who all feel they can make a contribution to decision-making, there is a lower clinical risk, fewer clinical complications and a better quality of clinical decision-making. Norway is a good model. The responsibility for provision in Norway is with the municipalities. That would be a challenge for us here. It is not with a hospital or an educational institute or whatever. That system has a lot to commend it because it is about allowing citizens to participate. There is a regional level of expertise and then there is a national centre for excellence, which relates to different specialist areas.

I agree with the Senator's frustration. I am not speaking on behalf of the HSE today but-----