Róisín Shortall (Dublin North West, Social Democrats)
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I will revert to the question on structures. A well-functioning organisation should be able to display its management structure on a one-page diagram. The diagram before me of senior management within the HSE bears no relation to what is happening on the ground in terms of the hospital, community health care organisation, CHO, and mental health service systems or primary care teams. This issue has been raised by many of the groups that have appeared before us, including staff groups represented by their trade unions.

One suggestion has been to consider a geographical division of the country into three or four health authorities, each with defined responsibilities for its senior people in terms of service delivery. Defined responsibility is lacking at the moment, as it is difficult to get to the person who is in charge of something. Deputy Browne mentioned how it might be a different person in charge of something from one month to the next. There is no clear line of sight in terms of accountability or budget spend. Has the HSE given any consideration to a geographical division of the country for its management structures so as to have a clearer line?

Will Mr. O'Brien comment on the level of confidence among staff in the workability of existing structures? We have asked almost every group that has appeared before us about whether it believes that the existing structures could deliver. The answer has generally been "No".

Regarding the delivery of community services, can the HSE provide a management structure diagram in respect of each CHO?