Mr. Tony O'Brien:

Yes, but my current position pending a discussion with the director general of RTE is that such things did not occur. Obviously, I will approach that discussion in an open-minded way.

In regard to the fundamental question raised by Deputy Kelleher, much of this issue played out in a room similar to this one on 21 July 2011. At the beginning of the meeting, my predecessor, Mr. Cathal Magee, included in his opening remarks a number of comments on the implementation of the small hospitals framework, which at that point unambiguously included Portlaoise hospital. The HSE took the view at the time, and still takes the view, that the notion of every hospital fitting neatly into models 1, 2, 3 or 4 is not quite right. These are not written on tablets of stone passed down from Mount Sinai; they are broad descriptions. Portlaoise does not fit terribly well in that it has many of the characteristics of a model 2 hospital and yet it has a very substantial maternity service. In some senses, it is model two and a half, if I can use that terminology. Obviously, it also has paediatrics and certain other attributes. Later on at that meeting, at which it appears from the transcript there was a heated enough discussion, although I was not there, the then Minister made a very clear statement of policy.

The legislation makes clear that it is not for the HSE or any representative attending a joint committee to question the merits of Government policy. The Government makes policies and public servants, as in our case, although civil servants in other cases, are obliged to do their best to implement them. I will not, in any sense, question that. However, there was significant dialogue between the officials of the HSE at that time, and I have seen much of the correspondence and spoken to the officials involved, of whom I was not one, seeking to see how the impact of that could be mitigated in all sorts of terms, bearing in mind that the one thing the HSE did not have available to it at the time was any resource or capacity to do what one might have wanted to do to take it out of the small hospital space and fully supporting it as a model 3, as elaborated. The other big challenge it has is that it does not have the level of activity in a number of areas to sustain it as a model 3 hospital.

What we do next will be done carefully because it is not a simple issue of turning something off and hoping things get better. Sometimes if one stops doing things, the situation gets much worse.

The 24-7 nature of its emergency department is not sustainable, but we cannot simply stop that until we have made alternative arrangements. That takes time. The hospital's critical care unit is not sustainable for a number of reasons relating to the resources available to it and the level of episodes of care which would be necessary to maintain expertise.

As I said in my opening remarks, it is clear in light of this report that the regulator, which has the power to do so, intends to hold to account those who are in our positions at any point in time irrespective of the resources available to us and irrespective of whether the decisions are made by us or in a policy context. Perhaps it was the regulator's intention to bring sharper focus to this. As director general of the HSE, I can tell the committee very clearly that in light of this development and in light of where we are now, we will take a much more robust approach to all these questions. That is going to be painful. Maybe it needs to be painful. We intend to conduct our business in a different way. For example, the submissions we make as part of the budgetary process for the coming year will focus strongly on all the identified risks on our risk register, will have monetary figures attached to them and will be published. This is a watershed in that sense. It has to be. If we are going to be held accountable for political decisions and for the resources that are or are not available to us, as perhaps we should be, we are going to have to embrace that and take it forward in a responsible way.

I will set out what it will not mean. Sometimes this is presented in simplistic terms. It may be suggested that at various times in the past, the right thing to do would have been to withdraw a variety of services from Portlaoise. There is a real possibility that if this had been done, it would have made things much worse in macro terms, taking the entire population into account. We will have to be robust, but that does not mean we will be silly about it. The resources we have are the resources we have. As a result of the economic recovery, the resources we have now are better than the resources we had before. The health service is getting into a better place in that sense. It is very clear that the judgment made in this report is that the HSE should have been much tougher about these things in the past. I think the only response to that is to be much tougher about them in the future.