David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I think Mr. Kearns is saying it is complex. My question concerned whether, at senior management level, the HSE is really committed to these changes. In his opening statement, Mr. Kearns said that there should be a guarantee of independence and authority for the RHAs commensurate with the responsibility they are being given. I agree with that. He went on to say we need absolute clarity as to how an accountability framework would work. I agree with that. He said there should be a bias towards providing maximum devolved authority sufficient to allow the RHAs to exercise effective decision making to deliver on their responsibilities. I agree with that also. Crucially, he talked about RHAs having a budget of multiple billions of euro and tens of thousands of staff responsible for planning and oversight of integrated service provision. He said the RHAs should have maximum devolved responsibility in all of these areas and that the bias should be towards effective decision making.

If you look at what was signed off on by Cabinet, this is where there may be some conflict with what Mr. Kearns is saying. It stated that the HSE centre provides all corporate functions, that is, RHAs are divisions within the HSE centre. The HSE centre provides central procurement, central finance control, central HR functions and ICT support to facilitate the use of shared facilities. It goes on to state that the RHAs are divisions of the HSE and cannot enter into contracts in their own right. They are not legal entities nor are they the employer. I can see a conflict between what I would want and Mr. Kearns's opening statement and what was in the business case signed off on by Cabinet. It also stated that no legal change is required. That is what was signed off on by Cabinet. If there is movement from the Government and the HSE, that is really welcome but when I read the business model signed off on by the Cabinet and then Mr. Kearns's opening statement, I see a conflict. Perhaps it is a healthy one but I see a conflict.