David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I wish to come back in on a couple of issues. It was impossible to get everything in in one round. I thank Mr. Kearns for his responses to the first set of questions. If I may focus on capital planning, there is a review of the public spending code or a review of capital from the perspective of the Department of Public Expenditure and Reform ongoing, I think. There is a need for reform in that area. Will Mr. Kearns give me his insight into how he sees the HSE estates working in a devolved situation? Is he a believer in and a supporter of multi-annual funding for health? When I talk to senior officials in the Department of Health, they say that having maybe a three-year cycle of multi-annual funding for both current and capital would be really helpful and would allow the healthcare system to plan more effectively. We have a similar debate in housing, where we have a four-stage process whereby plans have to be presented over and over again, working through multiple layers of accountability. One might say that that is necessary at one level, but it is too much at another level in that things do not get done. Will Mr. Kearns give me his insight into the types of changes he is advocating? This is an important area.

My view of the regional health areas is, as Deputy Shortall mentioned, that we now need to see a bias towards primary care and, especially, community care.

Once we give the RHAs a budget, I hope there will be a single tier of management that will manage the entire budget and, to use an expression, the head-butting of what is needed should be done within the RHAs within an envelope of money over a number of years. The RHAs will then have to prioritise where the spending should be. Rather than submitting endless business cases, which hospitals do - I do not know how many of those cases go to the Department but never see the light of day - and all the time spent on that, we should start to get them to focus on what is needed and to prioritise where the spend should be in order to get the best bang for our buck for patients. Mr. Kearns will appreciate the point I am making. I ask for his insight into how he sees that developing.