Mr. Leo Kearns:

First, what I would say about that is that they are central to it. So far, we have been talking about the integration of care, but that care has to be planned for on the basis of the population. Therefore, the RHAs need to understand their population and they need to deliver their services on the basis of the population need. That issue around accountability is fundamental.

In the advice we give, we are clear about this point and there is a commitment to that. I can see at a political level, within the Department and within the HSE, there is clarity that the budget has to move and that that is not just an administrative move. There has to be clarity that the RHA is accountable for its budget, that it has ownership of that budget and that it can make decisions within national frameworks. For instance, it would have to work with international framework on public procurement and within national frameworks around clinical programmes, such as the National Cancer Control Programme and so on. They have to have the ownership of that. In terms of the control model we are asking the HSE and the Department to design, our group will not be designing this but is simply stating the requirements that their model has to present. One of these is that there must be clarity about the responsibility, authority and accountability within the RHA, which incorporates all of that. I would say that there is a commitment to that as well as a growing understanding that it will mean radical change and that is not simply a matter of some kind of administrative move. Yet, we still need to see the control model, or the operational model, that will give rise to that.