Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputy for the questions. With his indulgence I might take a bit of time to answer these questions because they go to the core of some of the concerns I have heard raised. The first question is: who is in charge? I have seen this written about by many people. I am not sure how many of them have worked in the Department of Health. I have seen this question raised. I would say this, would I not? There is no question within the Department of Health as to where the direction of travel on policy and the initiatives we are undertaking are coming from. They are coming from Government and from me as Minister for Health, as the member of Government in the Department of Health. There is no question about that. There is plenty of evidence to that effect. I will not sit here and say just trust me on this.

Let us consider the course the Department has taken from the end of June 2020 when I was appointed. There has been a fundamental shift, involving a reorientation of the role of the State and the deployment of the resources of the State across the board. We now have strategic workforce planning, strategic infrastructure and strategic beds. We are mobilising all our resources around universal healthcare. The Deputy will have seen it; we have all debated this at length before. Enormous progress is being made on cost per patient. That is the first test of universal healthcare. Enormous progress is being made in services, including women's healthcare and other services. All of that has come from me as Minister for Health. Enormous progress is being made on waiting lists, emergency department trolleys and so forth.

We are doing that through a very basic strategy; there is obviously lots of complexity to it. There is an unprecedented level of investment, coupled with unprecedented level of reform. I will finish on this point, which is relevant. The Deputy very fairly raised the question and I have seen much written on it. Let us consider what the Department of Health and the HSE have been doing for the past three years. They are doing exactly what Government and I, as Minister for Health, have set as the task ahead in achieving universal healthcare in this country. Anything else is a kind of soap opera involving he said, she said. Ultimately who is in charge, the people who set the direction and say this is what we will do with the resources of the State? Robert Watt, as my Secretary General, is tasked with leading the Department on that. I believe that he has done and continues to do a good job.

The Deputy's second question was about accountability. I have two things to say on this. First, I respectfully suggest to the committee and to the Deputy that there has been accountability. He is perfectly free to disagree but let me just give my view of this. This was for a proposed secondment that never happened and that everyone believed was a good idea. Mistakes were made; those mistakes have been accepted. There was an initial report done by my Secretary General at my request. On the back of that an independent Government report was commissioned, which has been the subject of discussion at this committee. I believe Robert Watt has appeared at four or five public hearings about this one secondment issue. I would respectfully argue that this is quite a significant level of transparency and accountability.

That brings me to the second part of the Deputy's question, which is really important. I know that I am replying at length here and I apologise. However, if I may, I will just make the following point: one of the biggest problems we have in healthcare is that it takes too long to get anything done. Deputy Durkan and I have regular exchanges on this at the health committee. We would probably all agree with this. In terms of rolling out new strategies, legislation, authorising new medicines, building new hospitals, adding new beds, we take far too long to do things in healthcare in this country and ultimately the patient suffers. One of the reasons we take so long to do things is the civil and public servants involved are genuinely worried about making mistakes and then being dragged through a public arena and having their reputations attacked and so forth. It is a natural human reaction to say: "If I don't make the decision and let the Minister or Government make the decision, if I just pass responsibility up the chain all the time, then I will be okay. Nothing might happen on behalf of the patients, but I will be okay." That is not acceptable to me and I do not imagine it is acceptable to any of us at this committee meeting.

I will finish on this and I thank the Deputy for his indulgence. We have a decision to make. We can either accept that the public servants and civil servants will shy away from making decisions meaning everything will take too long and patients will suffer or we can ask them to make decisions. If we ask them to make decisions, while we must have transparency and accountability, we must also have an environment whereby we accept that people will make mistakes if we are asking them to make decision after decision. I thank the Deputy for letting me lay that out.