Mr. Tony O'Brien:

I am reorganising some roles and responsibilities but I am not fundamentally changing structures.

On the issue of beds and acute hospital beds on which I will ask Mr. Woods to say more, there is to be a bed capacity review carried out, not by the HSE but by the Department of Health. In our submissions to the Department when this was being mentioned as part of the Government formation process, our central point was that this should not be an acute bed review; it should be a total bed review taking into account long-term care beds as well rather than only acute hospital beds.

I touched on the governance issues around hospital groups. The delay in the appointment of boards has led to some ambiguity in the sense that we have groups which, by general public comment, are intended to have various operating freedoms but the reality is that the directorate of the HSE remains fully accountable for them and the legal authority that they have currently is through the delegation structure set out in the 2004 Act. I receive a delegation from the directorate and Mr. Wood receives a delegation from me and he parcels that out to the seven group chief executives and their authority is very much HSE authority, but, as was said, there are very different mixtures of underpinning governance in the different hospital groups. Saolta and the mid-west group, with the exception of St. John's, are essentially statutory hospitals where the governance is simple in that sense in that we can give full authority to an individual and state something is his or hers and he or she is accountable for it. In hospital groups which have a mixture of statutory hospitals and voluntary hospitals and the level of control of the group chief executive is through ownership of the budget and the service level arrangement with the voluntary hospitals, that is of a different quality. Obviously, we have had to take the view that we work with the raw material we have. There is no policy direction currently as to what way that will ultimately be resolved and the HSE does not have a position or has not taken a position, one way or the other. In other words, we are not saying they should all be statutory and we are not saying they should all become voluntary. We are saying all these groups are slightly different and there may have to be an eclectic set of arrangements, provided they are effective, clear and straightforward in relation to each group. We are not saying they all have to be exactly the same. There is a diversity in the health system. That is the way it developed. Some of that diversity has been good and some of it not so good. Mr. Woods will address the issue of Saolta and beds, etc.