Mr. Bernard Gloster:

I thank the Chair for his acknowledgement of the drugs decision yesterday. It is significant. Albeit the number of people involved is very small they are a very important small number of people. I was delighted to see it come forward. To be fair, I want to recognise the roles of the chief clinical officer, Colm Henry, and his team in this.

I said that I was taking on three challenges and the second of these is timely implementation. I do not believe the health service is short on plans. I certainly do not believe the HSE is short on plans. We are challenged by our capacity to implement them in a timely fashion. We can implement them but it takes us too long. This comes from a history long before the HSE was born in 2005. We come from various historical local structures. Convincing people that what is working in Cork is good for the people of Mayo can be a bit of a challenge. I picked these two counties only as an example and we could say the same about any other two.

The greatest challenge for a public service organisation is to have a sense of equity. We cannot have everything standardised but there should be a sense of equity and appropriateness. I often say that people in Donegal, Dingle and Dublin should have a reasonable chance of experiencing the same type of public services. This only comes with consistency. We have made this overly complex. We have failed to take the steps to identify quickly what works and to mandate it to happen across the system. We will still probably come up 20% short. It is the old 80:20 rule. If we got to 80% we would be an awfully long way down the road.

We have become risk averse. We want to think about a decision for a very long time. We want to study it and to analyse it. Sometimes this is good. We cannot just make decisions flying by the seat of our pants. We do have to reach a point of doing things in a timely manner. We have not been strong on this. To be fair to Deputy Cullinane, and particularly to be fair to the manager of University Hospital Waterford, it is being headed up in a particular way. Whether it is in Waterford or anywhere else if something is working I am obliged as the CEO to find out why it is not working everywhere else and why it is not happening. This is my job. If I do not do this I am not doing my job. These are the basics of accountability, sound management and strong governance. If I spend my life looking at what is not working then I will just looking at what is not working. Very often we have the answer and we are fearful for many reasons of scaling that answer quickly. I share the frustration of the committee. Something I openly discussed during the period in which I was being recruited to the job was that my potential weakness is perhaps my potential strength as a manager and that is that I am very impatient.