Jan O'Sullivan (Limerick East, Labour)

Does this constitute an admission that the centralised structure, which was the Minister's big idea a couple of years ago, has failed? This is how it appears to me. While I appreciate the Minister's reference to the Labour Party's proposals, I am unsure whether her proposals closely resemble them. On the one hand, the Minister spoke of not being more centralised while, on the other, I understand that everyone will report to nine national directors at central level. The Minister should clarify this point because I now am more confused about what is being proposed than I was after reading this morning's edition of The Irish Times.

Are regional structures proposed? The article that appeared in The Irish Times today suggested that such regional structures were proposed. The Minister has made no mention of regional structures and were such structures not proposed, I would welcome it because the Labour Party seeks the devolution of decision making down as close as possible to the patient's level. If the Minister states she agrees with the Labour Party proposal, its Members are on her side in that regard.

I wish to question the Minister in respect of a number of issues. First, how is one supposed to believe this? On the introduction of the HSE, Members were told there would be fewer layers of management and more staff on the front line. However, the complete opposite happened. Will more than 600 managers still be at grade eight and above? Before the establishment of the HSE, one could count such managers on two hands. The Minister stated there would not be an increase in staff. However, where will such staff be located and will new people be brought in? The Minister mentioned a couple of new posts and mentioned various directorates as new posts. Can the Minister explain to Members what exactly will happen in respect of staff? Does she intend to thin out the existing top management levels?

In addition, the Minister stated that, essentially, she would make decision making more streamlined between community and hospital care. Can she explain exactly how she proposes to so do? Will this take place at local level or does the Minister continue to refer to an entity that is led from the top, is centrally controlled and in which those who wish to make a decision in their patients' interests are obliged to go to the top?

As I noted at the outset, I am considerably more confused now than I was after reading the newspaper this morning because the Minister now appears to be stating there will not be regional structures. I seek clarity on whether there will be such structures. As for the implementation of this initiative, has consultation taken place? What is going on and to whom is the Minister talking? Has the measure been costed and has the Minister done her homework in respect of how it is to be implemented from the perspective of personnel and so on?

It appears that what has been proposed is a good deal more confusing than the existing structures. Having read the Fitzgerald report on Portlaoise, it noted, for example, that when meetings were held on what to do, although five different kinds of managers attended such meetings, not a single clinician did so. The meetings were attended by network managers, safety managers, hospital managers and all sorts of managers. How will the Minister's proposals address the need to have clear decision-making processes at the level of the patient and which do not constitute a continuation of the mess that is the HSE at present, in which no one who tries to make decisions that are close to the patient has the power to so do but is obliged to refer them up the line?

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