I thank the witnesses for their presentations and for all the work they are doing. In addition to raising awareness and trying to source grants from the agency, in some cases they are also trying to raise money voluntarily. Every organisation is involved in that.

I raise an issue in respect of healthcare. We seem to be continually increasing the expenditure going into healthcare and I am not sure whether we are doing it in the right way. I raised that issue previously with the HSE. People here may not be aware that an additional 16,000 staff are working in the HSE now compared with the number four years ago. I am not sure whether the witnesses are aware of that. I do not believe there has been any growth in the numbers of people working in the organisations the witnesses represent. Funding has not been given to increase the number of people in their organisations to the same extent as that which has occurred in the HSE.

In examining all these issues I have to consider the area of budget. According to the 2018 annual report of the HSE, more than €4.4 billion was paid out to the various section 38 and 39 organisations. That is a very large slice of the HSE budget. We seem to be reliant now on a range of organisations to deliver care in many areas. For instance, we are very reliant on Epilepsy Ireland to deliver care for people with epilepsy. Is there a need for a more co-ordinated approach? It must be the case that some organisations are delivering the same services. Should we consider if we can deliver better services by more co-ordination among existing organisations and the HSE? The HSE has looked at the way its funding is being used, but I am not sure if the organisations have considered if a better service can be delivered by them working together rather than independently. That is one area we need to examine.

More than 3,000 organisations get funding from the HSE. That is a very large number and is a huge amount of the HSE budget, but is that funding being used wisely? I am not convinced that the budget the HSE retains is being used wisely. As I said, 16,000 additional staff have been recruited over four years. I am mesmerised how that number has grown in such a short time.

Have the organisations considered doing a five-year or a ten-year programme? We have talked about Sláintecare, which is a ten-year programme. In terms of forward planning, have the organisations looked at whether a merger or amalgamation would be beneficial in some cases or the possibility of delegating work one organisation is doing where another organisation is also providing the same service? Have they examined that entire reorganisation issue? It happened in the trade union movement 25 or 30 years ago. It had a large number of different unions and they came to the conclusion that they would gain much more by amalgamating and working together rather than working independently. Has that issue been examined?

I have the list from the HSE's 2018 annual report and there are a very large number of organisations. I am aware that some of them are getting very large amounts of funding. Some of the voluntary hospitals are included in that €4.4 billion but it is still a major slice of the entire health budget. It is about whether we can deliver services in a more co-ordinated way in certain areas. I am not taking from the work of Epilepsy Ireland. No other organisation can replace it because the work it does is comprehensive, but there is duplication in other areas and I wonder if we can do a better job in that regard.