Mary Harney (Dublin Mid West, Progressive Democrats)

I do not want to talk specifically about the report but will talk about the plans, if that is in order.

I am delighted to have the opportunity to answer these questions. I confirm there are management changes taking place in the Health Service Executive. Work has been proceeding on these changes since the middle of last year. The CEO of the HSE recruited consultants to help him and the board of the executive to devise an appropriate organisational structure for the executive. Considerable work preceded the passage of the legislation to establish a unified service in 2004. Some called for its establishment as long ago as 1980. The legislation does not need to be changed as it provides flexibility to the CEO, which is appropriate, to delegate functions and organise the management structure as he or she sees fit. This must obviously be with the authority of the board of the HSE.

I have been in discussions with the HSE for quite some time. As we know, the higher review group on public pay drew attention last year to the need to have greater clarity regarding the management roles in the HSE. More recently, the Fitzgerald report drew attention to the systemic weaknesses in governance and management in regard to the events in Portlaoise. Following this, on 4 March, I wrote to the chairman of the HSE asking him whether the deficiencies identified in Portlaoise had wider application. In that context, the HSE is proposing it will continue with nine national directors but will consolidate, into one pillar, the National Hospitals Office and primary, community and continuing care. It believes it is appropriate when providing an integrated service to patients to merge the two pillars into one, not just at the top but right down the line. I support this.

Merging the pillars will mean that, at hospital level, there will not be confusion over whether a home care package comes from the hospital budget or another budget. The merger of the pillars will allow for a more effective response to the needs of patients. The population health directorate will be entering a new planning unit which will have different care managers. This will be headed by a director of planning, who will effectively be the person responsible for setting standards, making strategic plans and overseeing the implementation of change. The communications functions will be at directorial level. These are the changes taking place.

The HSE will continue to have nine national directors. It is simply a question of reorganising what they do, and particularly of elevating the post of director of communications to directorate level. All the directors will report to the CEO of the organisation and will carry out the responsibilities delegated by the CEO. There will be no increase in head count. Rather, when the new management structure is in place, as will occur over the coming months, the contrary will be the case.

At local level we want to consult stakeholders, particularly employees, on local arrangements and this will take some time. The intention is to recruit the directors at national level very quickly.

Recently, a new head of human resources started with the HSE. I had written to the HSE asking it to fill these posts because many posts at national level are held by people in an acting capacity, rather than by people who have been appointed to the positions. Clearly, that is unsatisfactory for an organisation that now is more than three years old. Consequently, I am delighted to note that a new head of human resources started recently with the HSE and he will be charged with overseeing the implementation of the new approach.

Essentially, what is happening in this regard is that many of the decisions that currently require approval at central level are being devolved to a more local level in respect of service delivery. One of the deficiencies identified in the Portlaoise report was that some people were managers for delivery of service, while also being involved in many strategic and national initiatives, such as negotiating with consultants or whatever. Clearly, those who have the responsibility to manage the delivery of services cannot focus completely on such delivery if they also are involved in national issues. The new organisational changes that are being made will bring an end to this, which is appropriate.

Many people have called for greater clarity and accountability. Many human resources gurus and management consultants have stated and advised — one telephoned me in this regard today — that to be able to devolve appropriately, one must centralise. One must know one's organisation and its capability. The HSE was not simply a merger of ten health boards and the Regional Health Authority. It also involved the merger within it of more than 50 different organisations. Clearly, before one even contemplates something like a redundancy plan, one must know what one's resources are, what resources one requires and what such resources should do. Notwithstanding the calls for redundancy programmes, the idea of a redundancy programme could not be entertained until clear organisational structure and lines of accountability were in place. As I noted earlier, this is a forerunner to giving consideration to what redundancy programme might be put in place, obviously on a voluntary basis.

Many of the changes that now are taking place have been called for in this House. More recently, the Labour Party outlined in a six-point plan proposals on how the Health Service Executive could function more appropriately. Some of these developments must be music to the ears of those in IMPACT and other trade unions who believed the decision making and day-to-day delivery of services to be over-centralised.

Finally, this change will involve an increase in neither budget nor headcount and will involve no change to legislation. Clearly, however, as Minister for Health and Children, notwithstanding the operational nature of the HSE's remit, it also is my responsibility to ensure that appropriate management and governance exists within the HSE. This is the reason the Department of Health and Children and I have been involved in detailed discussions over the past 12 months pertaining to the changes that now will be put into effect and which were communicated to the worker representatives through the unions this morning.

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