Dr. Sara Burke:

I do not have the answer. There has been constant reorganisation since 2001 - the Eastern Regional Health Authority, the HSE and then a continuous change in HSE structures. I agree with the Chairman that the current structures are not optimal. That we have hospital groups that are not matching with community health organisations is problematic. I agree that we cannot ignore it, but we should not undertake just a reorganisation. Previously, the only thing that happened was the reorganisation, which did not improve how people accessed our health services or their experience of those services.

I do not know whether the committee has spoken to some of those within the HSE or internationally.

Perhaps Professor Josep Figueras can talk to the committee on this issue again next week. There are many models around integrated care pathways and last week we were talking about care pathways for people with multiple morbidities. There is a growing international literature on that which is not necessarily about restructuring. It is about improving the patient experience and pathway through health services. What needs to be the focus is the citizen's experience of the health system rather than the top-down structures that we have, faulty and all as they are.