Jack Chambers (Dublin West, Fianna Fail)
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I see it as a dilution of the commitment to recruitment and, therefore, we will agree to disagree. I still believe that face-to-face assessment is better for a 14 year old in the circumstances the Minister of State outlined. I am not sure how the full criteria can be met according to international guidelines, in the light of the information and communication technology guidelines, the mini-mental State examination and the whole process of examination. While there might be advances in this regard, and while a platform can be built and it is fine to have a vision, if we are to reflect the Sláintecare vision of healthcare in Ireland, the focus should be on replacing the posts rather than on what the Government is doing, namely, replacing proper recruitment with telepsychiatry.

In his statement, the Minister of State did not mention the elephant in the room, which is the 80% rise in management spending in the HSE in the past five years. In 2012, there were 744 employees at grade VIII but there are now nearly 1,400. What are the Minister of State and the Department doing to address the continuous growth? Every year it seems the first task of the HSE and the Department is to fill the management positions for people at middle and senior levels and there is a merry-go-round of filling the vacant positions. The reality of healthcare in Ireland is one of constant spending and bloating. The front-line workers, whether they be doctors, nurses, healthcare professionals or even secretarial and clerical staff, are the ones at the coalface who are told they must manage and continue as they are if someone leaves. The bloated top, however, continues to grow.

I recognise that Deputy Jim Daly has had responsibility in the Department for only two years but, as a Minister of State, he has a duty of oversight to say "Stop." What is he doing as part of the budgetary allocations to stop the continuous bloating in healthcare organisations, which frustrates everyone on the front line, and the growth in figures? Even at the peak of the recession, people continued to be promoted to more senior positions and their own positions were filled. It continues to become more top heavy. If we are to grapple with difficult budgetary allocations, it needs to happen at all layers and levels, and management is an important issue.

We know from representatives from the HSE appearing before the committee that nobody takes responsibility. There are many managers in many different areas but the buck stops with nobody and they do not meet any of their targets or outcomes every year. For the acute hospital budget, the Department of Public Expenditure and Reform stated that hundreds of millions of euro was allocated but there was no indication of the output or the service-level improvement, and there are more managers managing that budget every year.

What is the Department planning with the HSE to address the continued bloating?