Mr. Bernard Gloster:

I thank the joint committee for the invitation to appear and for the opportunity, having taken up the position of chief executive officer of the HSE two weeks ago, to outline my priorities. I am joined by Mr. Ray Mitchell of our parliamentary affairs division and Ms Níamh Doody, my executive business manager. I thank the many stakeholders in our health and social services space for their warm welcome for my appointment to this role. It is one to which I was very privileged to have been nominated following an open public competition process. I extend my thanks to Mr. Stephen Mulvany. He has been interim CEO of the HSE for the past five months and his efforts in one of the most pressurised periods for our hospital and community services deserve recognition.

I am conscious coming to this role that there are many challenges. However, there has been a significant improvement recorded in recent years in the overall health of the population. Reduction in mortality rates and gains in life expectancy are important markers of the improvement in population health and underline the importance of the services in place to promote and protect their well-being, as well as services that treat people when they are ill. Overall, there are more people in Ireland and we are living longer than before. The life expectancy of the Irish population has made the strongest gains among western European countries and is now above the EU 27 average. In 2021, life expectancy was 84.4 years for women and 80.8 years for men. Those are increases of 1.4 years and 2.2 years, respectively, in the past decade, compared with increases of 0.1 years and 0.5 years for the EU 27 in the same period. Gains in life expectancy have been driven by sharp reductions in mortality from major diseases. The leading causes of death in Ireland include circulatory system diseases - like stroke and heart attack due to ischaemic heart disease - cancer and respiratory system diseases. In the past decade, the age-standardised mortality from these causes of death has reduced by 33.5%, 18.2% and 33.4%, respectively. Infant mortality rates in Ireland are low, as is the case in most European Union countries, and fell by 14.3%, to three deaths per 1,000 live births, in the decade to 2020.

I recognise that I come to the HSE at a time when all of our staff have been through several years of additional and demanding periods. These have been due to the need to respond to a pandemic, cope with a cyberattack and work through one of the most challenging winters on record for health services. The success of our combined community, acute and public health teams in mitigating the impact for so many cannot be understated. Bringing together large parts of the workforce in crisis times, as was evident in the response to the recent fire at Wexford General Hospital, is a pointer to what can be achieved by that same integration in normal times.

It is an enormous privilege to have been appointed to this position. The confidence of and mandate from the board of the HSE, the Minister, the Secretary General and the Department are very reassuring as I begin to provide the management and leadership for a period of extensive change and improvement for the HSE. I come to this role as an experienced senior public servant with more than 34 years of service, from front line to CEO, in the Irish public health and social service system. Most recently, I served as CEO of the Child and Family Agency, Tusla, which is an organisation coming through progressive growth and reform. I value the experience I gained there in my approach to the role I have now taken up. I am a former professionally trained social care worker and I hold master's degrees in business administration and management practice. In my various roles, I have either worked in or managed every operational part of the statutory healthcare service, including both community and acute operations. At times, I have done both. I have held local, regional and national roles.

I bring significant regional experience at a time of HSE restructuring aimed at giving effect to a more decentralised model of decision making. This 18-year-old organisation has been through several iterations of change, be it in policy or structure. It is the summation of and learning from that history, combined with the potential of an enormously dedicated workforce and the overarching guidance of strong Government policy, that creates the opportunity to make substantial improvements. A clear understanding of the guiding policy context for the HSE over the next period is the combination of the programme for Government, Sláintecare and the various subsequent action plans resulting from it, and the priorities of the Minister set out, from time to time, in his various directions to the HSE. Arising from this, the Minister has emphasised and set a number of issues to be prioritised in 2023, most notably improvements in direct experience of the public in terms of access to healthcare and in urgent care. These come in addition to the critical focus on issues like outcomes, affordability, capacity and effectiveness in care delivery.

Against this backdrop and my own assessment of the current state of play, I have highlighted three headline challenges to which I intend to respond during my tenure as CEO. The first is access and performance. The second is timely implementation, and the third is public confidence. The organisation requires attention and significant step change on several fronts in responding to these challenges.

The organisation has many dedicated and talented people across all disciplines. It is, however, important to accept that while responding to many issues over the years, it is an organisation that has become a top-heavy structure with many cumbersome processes. The opportunities presented by Sláintecare and the programme for Government priorities will assist in tackling some of these issues. Structure itself, however, is not an answer on its own.

While there are well-evidenced capacity and demand issues to be addressed, and there are good plans to do so, there are also process issues to be improved and with decisive management and leadership, these can and will be tackled ahead of structure changes. I will, with the board of the HSE, be positioning all changes in an integrated framework focused on care, culture and governance. If we do not pursue changes in all three together, we will have completely missed the opportunity to be the best health and social care service we can be for the people we serve.

While there is enormous good to report in and about our services, I do not accept that as we work through 2023, with a budget of some €21.6 billion revenue and a workforce approaching 142,000 whole-time equivalents, that we are yet near to being that best we can be right now. The well-documented experiences of the public and our front-line staff must be enough motivation for that position to improve.

In setting early priorities, it would be impossible within the scope of this statement to list all areas of focus and I have grouped some together, noting the exclusion of any part of the service here does not reduce its value and importance to me as CEO. This committee, in its work on Sláintecare progress and updates, will be familiar with the many components of the current action plans. All of those can be taken as read in being central to my future work and I am currently being briefed on the detail of each part. Among these requiring attention in pace of progress are elective care reform, e-health and digital health combined, regional and centre structures, enhanced community care pathways, the consultant contract, waiting list plans, and adding capacity both in staff and infrastructure.

Ahead of the regional health area, RHA, proposed changes, I have taken direct management responsibility for the HSE part of this change. To ensure that we do not wait for that alone, I have also introduced some significant interim management changes in the management processes, to take effect from April.

I am conscious that the HSE has a brief far beyond the projects listed in the Sláintecare programme and in this regard, both the programme for Government and my own assessment of issues require that I also emphasise and devote attention to some specific issues. I specifically want to refer to women's healthcare, mental health, disability services and care of older people. Care measured against regulatory and best practice standards for people in these groups must be the priority in any improvement plans. The HSE cannot, in its social care system, allow for any avoidable delay in responding to access, quality of service or safeguarding issues for people who experience vulnerability.

In a post-crisis period, there is little doubt as to the many challenges faced by the public in how they experience health and social care services from the State through the HSE. With those challenges are also many opportunities. Strong and robust plans are there, and it is the implementation of those that the HSE must remain focused on, and look for every opportunity to shorten the timeline for the benefit to accrue for the public. That is where my time as CEO will be directed to, and I look forward to working with and updating this committee over the next period. I thank the Cathaoirleach.