Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

To pick up on the last point made by Deputy Sherlock, there is an excellent example of what a community pharmacy can do in Cloyne. I am very familiar with it. That is a model that should be replicated all over.

I very much welcome this motion. It is timely given the horrendous few weeks we have come through. At this point, after the last two or three weeks, some of the measures taken have kicked in and they have been relatively successful insofar as the indefensible figure of 930 people being on trolleys has been reduced to a somewhat more manageable but still unacceptable figure of more than 500. Actions were taken that were effective. I completely agree with the Minister in respect of people coming in over the weekends and ensuring there was patient flow and all that kind of thing, which is so important. This is obviously what we should be aiming for. Doing it with a reduced staff capacity and a reduced number of beds, however, is not sustainable in any kind of long-term way. The additional hours people worked on top of their normal week, the extra overtime and all of that was very effective and showed us what can be done if we have sufficient staff. Fair dues to the people who did that but, as I said, this cannot continue because people are already wrecked after the last two years. A big effort was put in and we did get rewards from it.

We must stop staggering from crisis to crisis. The Minister knows the definition of madness is when we keep doing the same thing and expect to get different results. This seems to be what has been happening winter after winter, except that the crisis that used to exist during winter now rears its head several times during the year. There is, therefore, much to be done. Many good suggestions have been made in this debate and lots of people have ideas. The key point is the implementation of these ideas because we cannot again find ourselves in a situation like the one we were in over Christmas. The Minister must accept that is utterly unacceptable. It must also be accepted that it was, in large part, entirely predictable. Last September, for example, Fergal Hickey told the Minister that we were facing Armageddon. He predicted that winter was going to be disastrous, yet plans did not seem to be put in place to cater for that. We knew that Covid-19 was going to spike again and also that the flu was going to be a major factor.

What is to happen? I accept what the Minister said. There have been additional beds, but they are not enough. There have also been some additional staff, though not enough. I will return to the point on staff in a moment. The most urgent issue that needs to be dealt with is the manner in which we run the health service and the manner in which the HSE operates. It is very easy for people to criticise the HSE and a predecessor of the Minister had plans to abolish it. All that kind of talk is nonsense. The HSE is our health service. What we must do is reform it. There are major problems with the way it functions. It is quite a dysfunctional organisation. It is highly centralised. It is a command-and-control organisation and hierarchical. When something goes wrong, whether in south Kerry, north-west Donegal or wherever, the CEO comes on the airwaves apologising and promising us a report. We cannot function like that. It disempowers managers down the line and means that managers become administrators. We pay a lot of managers and we should expect them to manage. This means placing responsibility on them and them then being responsible for spending budgets. It means ensuring those budgets are properly spent, we get value for money and services are managed so that they are adequate. We must stop talking about it being great that we are throwing money at the health services. I heard a Minister of State use this phrase last week on television. She said we are throwing money at the health service. We are spending a huge amount of money but we should not be "throwing" money at it. We need to be directing money to where it is most needed. Most of all, we need to reform the way the system operates.

The plan is there for the reform of the HSE, as the Minister well knows. It is the regional health authorities, RHAs. The Sláintecare plan came up with that as the key element six years ago. The Minister of State, Deputy Naughton, was involved in that cross-party proposal and yet progress on that specific aspect has been exceptionally slow. We are looking at this element in considerable detail on an ongoing basis in the Joint Committee on Health. In October last, the chair of the advisory group to the RHAs, Leo Kearns, appeared before the committee. He stressed the importance of devolved authority to allow each RHA to exercise effective decision-making. The guiding principle that should underpin this restructuring is that of subsidiary.

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Authority for decision-making is devolved, responsibility is devolved, people are empowered to manage the service, and that must be underpinned with legal accountability. That is how we get the best out of people. Responsibility lies with senior people in the region.

We know what has happened and the memorandum that was brought to Cabinet last year on that. I am not sure where that originated but all of the evidence would suggest that, at a senior level within the Department of Health and in the HSE, there was serious institutional resistance to the breaking-up or restructuring of the HSE. We know that two very senior and effective people, Ms Laura Magahy and Professor Tom Keane, walked away, unfortunately, because they said the Government is not serious about this. Given the fact there are undoubtedly obstacles and there is institutional resistance at the top of both of those organisations, I repeat, and I have said this a number of times, that it was a mistake to put the heads of those two organisations in charge of implementing something which might discommode them, which they may be uncomfortable with and which they may not necessarily want to see happening.

We are in this situation. The Minister has to listen carefully to Mr. Leo Kearns, who does not pull his punches. He is involved with an experienced group of people in the advisory body.

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