Mr. Paul Reid:

I agree on how important it is to deliver on the funds committed to us in our budget. I reiterate the Minister's point that in going through this process we will need to invest in transformation in the future. I have never been involved in any major transformation that did not need investment. Everybody understands that and it is explicit in Sláintecare. I am wise enough to state that we first have to do what is necessary to strengthen trust and confidence and then invest funds in the future model. I am committed to doing that. The Minister remarked on the structures of the HSE. I welcome the new board and, although not yet appointed, I have met all of its members individually. They will bring great expertise as well as a level of challenge to the executive structure. We look forward to working with the chair and the board on our current priorities and also on those that the board will set for us, in conjunction with the Department and the Minister.

Reference was made to the making of just decisions in situations where things are too expensive. We have to make those decisions. As I stated earlier in the context of the discussion on Spinraza, I thank the drugs committee for doing fantastic work overall and making those difficult decisions for us throughout the year. The committee makes decisions using a wide range of criteria and has approved drugs that would not be cost effective but that are necessary for the people impacted. Many of the 23 drugs approved this year have not been cost effective. We have to make some decisions, therefore, in the public interest.

Turning to the chain of command and regionalisation, I agree completely that people in any large complex organisation, particularly the workforce, mostly identify with their local unit, manager, hospital or primary care centre. A stronger identity will emerge, therefore, as we move to a regional model. It is a model derived from the policy of the HSE and the Department of Health. As we move to that model, in respect of central policy making, involvement, employment and particularly achieving consistency, the last thing the public and the public health service need is a regional model with different models applying in different areas. That is my view and it is also reflected in Sláintecare. It will be regional and that will encourage people, and in particular the workforce, to buy into the service while a level of consistency and control is retained at the centre. That is the model we all want to see.

The Minister also referred to the NTPF and its impact on waiting lists. I see the NTPF as a great lever. Many local managers in our acute hospitals, including Ms Grace Rothwell who is here today, are leveraging and using it in a proactive way to address waiting lists. In Irish private and public hospitals, people travel overseas under the auspices of the HSE and not the NTPF. It is deployed in our public and private hospitals.