Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome the witnesses and thank them for their presentations.

Mr. Watt's opening statement refers to refocusing the health service and moving away from acute hospitals to community care and developing the area of social care. This is a key element of Sláintecare. I agree that there are very positive signs about framing that process of refocusing. The proposed hubs are a very good example of that. I am beginning to see it in my constituency and that is very positive. However, the downside is that while there seems to be a commitment to the theory and to funding, the big obstacle is recruitment. Yesterday, when discussing the Supplementary Estimate we saw where there were savings of €500 million. This represents approximately 8,500 staff. It is bad enough seeing it on paper but we all see it in the real world where kids are left waiting months, if not years, for basic services like assessments of need, access to speech and language therapy, etc. There are huge numbers of older people waiting for home care. This gets back to workforce planning, which is a bit of a hobby horse of mine. We were assured by the Department of Health and Mr. Paul Reid of the HSE that intensive workforce planning was taking place and we would receive documents to support that assurance. We never received those documents. These problems are going to continue to dog the health service unless and until there are proper workforce plans put in place. I have not seen any evidence of those. When we talked about recruitment previously in this committee the HSE and the Department of Health spoke only about recruitment. There is a distinction between recruitment and workforce planning. The latter goes right across all grades in the health services, not only doctors, which Mr. Watt seemed to concentrate at our last meeting. Doctors are one part of many different parts. Planning is needed in terms of placements, training places and university places. I have not seen any workforce plan for the health service and that seems to be a major problem. When recruiting, it is all very well to have the money but the people are not there. Getting that right has to be central. I am still waiting to see the workforce plan for the HSE.

On the question of RHAs, the Sláintecare committee was adamant about having a separate implementation office. That office should have been in the Department of the Taoiseach. The office was set up in the Department of Health. Unfortunately, that office is now gone. We were told by the Minister that the head of Department and the head of the HSE would have responsibility for implementation. The RHA plan is probably the biggest organisational restructuring within the public service we have ever seen. I cannot think of anything that compares with it on the basis of scale. Given that both the Department of Health and the HSE are in constant crisis mode, I wonder how a major restructuring programme can be implemented without a separate office. Who is responsible for the Sláintecare implementation and particularly the RHA restructure? We know Mr. O'Connor on the Department side and Mr. Woods on the HSE side have responsibilities. I do not know if that is their sole responsibility but there does not seem to be any group in place to manage the change. Change management is a very challenging issue in any organisation. There has to be an acceptance that in any major institution there is resistance to change. That is not criticising anyone here. It is a fact of life that this is a feature of trying to implement change. Who is responsible for addressing the issues of resistance, getting buy-in and so on?

Of the two briefings that we had, the first one in the Department was very encouraging but the second raised many concerns. It seemed that this committee, the advisory group and the feedback from the consultation with various staff groups were all saying the same thing. If this is going to be done, it has to be done properly. It is not about going through the motions but having real devolution and subsidiarity. That means taking power from the centre and devolving it. We need to see a list of all the functions of the health service. Then a decision has to be made on which ones are most appropriate to remain central and which ones are most appropriate to be devolved. Will Mr. Watt assure the committee that this will happen prior to the recruitment of the people who will be leading the RHA? It should have also been clarified prior to the advertising of the new chief executive of the HSE. This is one of the most challenging aspects of the job. How is all of that being handled?