Mr. Bernard Gloster:

There are three things that are essential to that. First, the CHOs have been subsumed into the six regions and are working hand in glove with the hospitals. There is now one single management system. That puts a different lens on the CHO and its value. Second, on making sustainable improvement, the investment in CHOs over the past three and half years, particularly with the enhanced community care which we have presented at the committee previously, and Sláintecare, has shown remarkable levels of response to need. While it does not often look like it is impacting on lists, services or systems, it is impacting with huge benefit to the public. Third, the CHOs that might be challenged in a particular care group could not be said to be consistently poor or weak. An area might have a strong challenge in mental health services but might be the best area in the country for delivery of older person services. Much of that is influenced by history, availability of skill set and by different things like varying degrees of investment historically. Investment is much more level now, or is at least moving in that direction.

There is a lot of focus on performance and accountability. For example, what was traditionally called the home help service, the home support service, has reached the delivery of its full target of home support hours and more. This is the first year that the health service, in my recent memory, has done so. There are arguments about how it was adjusted up and down and that it should be more, but leaving that aside, for many years the amount of money and the amount of hours that was available could not be achieved. It is now being achieved. There are underpinning improvements being made that are helping what were CHO areas to improve their delivery and performance to the public. I do, however, accept that we have a way to go in that.