Dr. Emer Begley:

A huge amount of our advocacy representative work is with the HSE or members of the national consultative committee at the HSE centre. There are regional disability consultative structures. We have members on that. We have an internal advisory group structure where we share the information. The fragmentation is massive within the HSE where decisions are made more on a personal, subjective view, and there is a huge lack of equity across the country because it is a geographical lottery based on where you live. It is huge. Without a national model, you are leaving interpretations at a local and a regional level. There is also the new health regions structure with the six health regions. We are working hard for proper representation at those structures for both voluntary organisations and patients and service users. That is a massive area where there can be pushing for standardisation and equity of access at a local level. Unfortunately it goes back to who shouts loudest and where there is strong advocacy. At an individual level, where there is strong advocacy, people tend to get the hours or to get more service. That is not right. It is really not right.