Mary Harney (Dublin Mid West, Progressive Democrats)

As for the new directorates, I wish to make clear that the people at the top, including the chief executive officer, are responsible for strategy, standards and configuration of services, such as, for example, the cancer plan. Professor Keane is implementing the cancer plan and this is a national role. Clearly, however, he has people at local level who are responsible for implementing it in Cork, Galway, Dublin or wherever. I wish to distinguish between service delivery, that is, the implementation of the strategy, and the people who are responsible at the top. In this regard, there will be a new post of clinical affairs director. I believe it is extremely important to have a clinician at national level with responsibility for risk assessment, protocols and the kind of issues that have emerged in recent years. The public has much greater confidence in a clinical response than in one from someone who does not have a clinical background. In fairness, Professor Drumm identified this deficiency approximately one year ago. He has put this in place at local level, including the Deputy's own area, where she is familiar with Professor Lyons who has responsibility for the implementation of the changes there. I believe this will work well.

The communications job is being elevated to director level because, as the Fitzgerald report highlighted and Members are aware, the HSE faces a major communications challenge to communicate what it is doing and to inspire confidence in the wonderful new things that are happening. I have stated in other fora that the HSE is somewhat like German unification. While it was known the principle was right, it takes one a long time to put together all the pieces. The current cancer plan, which is based on eight centres, would not have been developed had the health boards continued in existence because a number of areas will not have a designated centre. Similarly, we would not have consistency and uniformity in the way nursing home standards are being implemented. We would not have the current focus on where services are provided if the local hospital, as the Taoiseach said here the night he was elected, was the centre of the medical universe. We know high quality service cannot be provided at local level. None of that is possible without a unified organisation and I remain convinced it is the right way to go. As the Deputy is aware, other countries are going down the unified organisation route but that is not inconsistent with ensuring that for the day-to-day delivery of service, responsibility rests as close as possible to where services are provided.

The Deputy asked me about front-line staff on which I have given the statistics previously. It is wrong to say there has been an increase in administration staff at the expense of frontline staff but it is true that under the old health board regime there were many people in managerial roles with various titles and when a single organisation came together, both as a result of that and through IR issues that arose in connection with it, there was greater clarity on that aspect. I look forward to a reduction in the number of people in management positions but a precursor to that must be to have clear lines of accountability and responsibility before we go down a redundancy route. The purpose is to reduce the layers of bureaucracy.

On the Portlaoise issue, which the Deputy mentioned, one of the criticisms was that the person responsible for the hospital was also involved in a great deal of national activity and clearly one cannot do the two. That is why it is important that some people are concerned with the national focus. In some countries some people are involved with the reform and others get on with the delivery of the services on a day-to-day basis. That is what is happening here and it makes a great deal of sense.

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