John Perry (Sligo-North Leitrim, Fine Gael)

The establishment of the HSE marks the latest attempt to introduce national priorities and effectiveness into the delivery of the health services. One particular aspiration of the new HSE structure was to bring skilled and professional managers into senior positions, thereby ending the near-permanent state of budget crisis that characterised the old health boards. It is to be regretted that the HSE should be engulfed in a budget crisis of its own making so soon into its corporate life. As the crisis appeared out of the blue this September, were any delegated administrative and financial controls in place? Was the entire management hierarchy asleep throughout the summer months?

A total of four consultants were informed they were being let go from their posts at Sligo General Hospital. One week later, the breast surgery and ear, nose and throat consultants were informed they were being given a three-month extension to their contracts. Such events raise serious concerns regarding the quality of management and professionalism within the HSE. I understand it is difficult and complex to try to introduce management control and discipline to such a large structure. Consequently, I will accommodate reluctantly the viewpoint that lessons are being learned. However, it is unfortunate that this is taking place at the coalface. I hope the aforementioned type of management fiasco will be brought under control.

I seek a response from the Minister to some simple questions. What performance factors are used to determine the annual bonus payment made to the HSE's management? Is the achievement of the annual financial budget target one such factor? Will the Minister issue a written directive to the HSE in respect of bonus performance payments this year?

The HSE is an extremely large organisation with a massive financial budget. At present, it has the appearance of a large circus elephant that is behaving badly. While some questions arise regarding management competence at various levels, another factor is the obstructionist behaviour by various staff representative bodies. Partnership must be a two-way street to be meaningful and to the ordinary citizen, it appears that significant management decisions on resource allocation and flexibility in work allocations are contested endlessly. A management that is obliged to battle relentlessly with its own professional staff to achieve any worthwhile changes will be diverted from achieving its primary focus on quality patient services. There is no national crock of gold to be tapped to keep the money pouring into the health service sector. At present there is a bizarre combination of additional money being poured into the health services while simultaneously, front-line services are being curtailed and cut back. I am advised reliably that the mammography services will be withdrawn from Sligo General Hospital by the end of the year. This comes on top of the loss of 30 nursing posts and four consultant positions. While front-line positions are being cut, there is not a single reference to administrative and management positions taking any of the pain. To the citizens, it appears that this PD-FF-Green Government, and specifically the Minister for Health and Children, Deputy Harney, has lost interest in effectively running the health service and delegated all the functions to Professor Drumm and his team. As the Minister responsible for health sector reform, she must take firm control. She has established this arrangement and she must ensure that it delivers real value for all the extra taxpayers' money being spent. That is not taking place. She cannot evade responsibility or hide behind subterfuge. The country will not accept the continuation of this situation and I ask the Minister to deal with it.

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