Mr. Bernard Gloster:

Yes, it is fundamentally different from accountability. I have talked about that here many times and how I discharged it and how I continue to do so in my job. The standards of accountability that are discharged now are much more clear and visible.

In relation to culture, people often say it is like fresh air and ask what we are actually talking about. I am talking about the fundamentals, about how we treat people, how we as an organisation are experienced by patients, how we treat them, how we talk about values and how we live those values in our behaviour. What I would specifically point to is the number of what we call patient partners or service users, who now sit directly in very high decision-making processes and functions within the HSE. This brings not just a level of transparency but also inclusion that was never here before. The culture of the Irish public service and of the health service traditionally has been a very paternalistic culture. We tell people what is good for them and we give it to them whether they like it or not. Modern day healthcare systems do not operate like that. There is much more openness about what goes well and what does not go well and there is much more inclusion of the public in trying to find solutions in how we design healthcare, so that is what I mean.