John Brassil (Kerry, Fianna Fail)
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In his responses to the questions we sent him on recruitment, Mr. O'Brien stated the HSE is looking for a chief operations officer and a chief strategy and planning officer, and he provided a list of other changes he would like to bring about. He states that both roles mentioned will be filled as soon as is practicable. This is of concern to me. Why is it so difficult to get people in place for such critical roles? The HSE should go about recruiting for a particular critical role and appoint a group to advertise and interview, or do this internally. A working group should be established to acquire these individuals, a timeline should be set and they should be appointed. To state that the positions will be filled as soon as practicable is too open. I would much prefer to see a statement that these roles will be filled by the first quarter of 2017. This would create a target for which somebody would be accountable. If the person is in place, that would be great. If, however, he or she is not, we could ask why that is the case.

I agree with Mr. O'Brien that it is very difficult for anybody to make an assumption on whether the hospital groups are working if they are not working optimally. The seven hospital groups came before the committee. I was very impressed by the set-up in the mid-west and felt it is working quite well because of the structures in place. It carries out routine procedures in its category 2 hospitals, which frees up capacity in its category 3 hospitals. I thought this was a very simple way to do business which improves efficiency. The next obvious question is why this does not happen in all of the other groups. It should be happening and we should make it happen.

I asked each hospital group whether it recruits as group or individually and I received different answers from the various groups. Recruiting as a group should be the only way it is done. To go back to the area I know best, which is Kerry, it is extremely difficult for Kerry University Hospital to recruit but it is not as difficult for Cork University Hospital. If the group recruited, the doctors, nurses and consultants could be assigned so there would be no cherry-picking by people who want to go to where all the activity is. We would have much more successful outcomes. This system exists in the mid-west where recruitment is done by the group, but the latter is not done in the area from which I come. It should be compulsory.

Again I return to the question of whether it is possible to make this happen. Mr. O'Brien mentioned the success of acute stroke units. There is no acute stroke unit in Kerry University Hospital, a category 3 hospital. There is no cardiologist in the hospital. It depends on a phone call up and down from Cork once a week. These are structural issues that can be addressed if tackled properly. The people in Kerry to whom I speak say the people in Cork, if they are of a sympathetic mind, might come down and help us but, if they are not, there is nothing we can do about it. The cost of recruiting staff through agencies is three times that of recruiting staff directly. If a group recruitment system were in place whereby staff were sent to the less attractive areas, this issue would be solved and the less attractive areas would become more attractive with the increased staffing. One problem solves another.

Regarding the shift to primary care, do the witnesses have any figures or data as to what kind of investment is needed in primary care to make it work and subsequently take the pressure off the hospital system down the line? From the first day this committee met, the message of investing in primary care to help solve the issues further up the line has been coming across. Mr. O'Brien mentioned the New York model. New York had a specific savings target and investment budget. Do we have anything like that? If not, we should seek it. If we know what to invest in with a degree of - I will not say certainty - hope that if the work is done, significant moneys will be saved further down the line in the hospital system, then it is worth investing in it. Do the witnesses have any figures that would help us in this area?

Mr. O'Brien mentioned IT although he said he would not spend much time discussing it. It comes across to us that IT is one of the most important areas in which to invest to allow savings to be made and the system to run efficiently. Do the witnesses have any figures as to the amount of money needed to invest in IT to get us to where we want to be? This is critical.

Regarding Mr. O'Brien's issue with 12-month budgets, I do not know of any organisation that does not operate according to such budgets. The whole country operates this way. By what system does Mr. O'Brien suggest we operate? What different model could we consider? Nearly every organisation I know works according to an annual budget. What would Mr. O'Brien like to see done differently to this to help the HSE do its job?