Dr. Tony Holohan:

With regard to the movement of people within the HSE, I understand the point he made. It is not good, in terms of stability, to have continuing change of the nature he described. An additional dimension is the movement of medical teams and other services. By design, the provision of medical services involves the movement of staff on a continuing basis. Work that has to happen in the future and which we have to get better at as a healthcare system relating to putting standardisation in place. As a random example, junior doctors moving from one location to other may have to interface with a different prescription system for prescribing and writing up medicines.

Why should that be different in every hospital environment? Why should it be a new learning that must take place separately in every hospital? If teams are changing on a continuing basis, in as much as possible there should be standardisation of that which can be standardised and that reduce the risk to patients. I refer to the ways in which medications are stored and all those kinds of things. A lot of work is happening in the HSE as things stand to try, through its quality improvement programmes, to push on some of these kinds of issues. However, I offer that just by way of example and I take the point the Senator made.

Regarding the question of administrative decisions, I would not support the idea that an appropriate medical decision be taken by someone other than the person who is appropriately medically qualified. It is also fair to say, however - and I do not make this particular point in the context of the example the Senator has chosen - that there must be a situation in which doctors, in the provision of services, are open to the idea that there are ways and means of doing things that work better in some situations than others. Sometimes one can encounter resistance. Sometimes it can be the case that doctors will cite things like medical autonomy as a reason not to engage in something in which they do not want to engage. I do not say that is what is happening in this situation. It can be the case that there is good evidence around how one organises and schedules theatre lists, for example. Perhaps not every surgeon will welcome such engagement coming from his or her leadership, and that does not mean they are wrong. I see both sides of that argument.

All of Deputy O'Reilly's questions are new so perhaps I can address some of them. Under head 4, alternative and complementary therapies are excluded. There is no proposal at this point in time to make regulations in this regard. I had an opportunity to talk a little about this in the context of our recent discussion at this committee about chiropractors. As it stands, we have no plans to regulate alternative and complimentary therapy.

Regarding HIQA, I take the points Deputy O'Reilly has made about the monitoring of compliance. The regulations the Minister will have power to make under the Act will essentially set out the mandatory standards and HIQA will set other standards, which will be non-mandatory. Perhaps this "need" to do things which will be the subject of mandatory standards is too loose a way to describe it. Then there will be things that will be, dare I say it, nice to do. In any environment, one has a floor set of standards that must simply be in place for basic safety, governance and operation of a service. That is the basis-----