Results 3,901-3,920 of 26,396 for speaker:David Cullinane

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I must put it to Mr. Kearns that if we are talking about devolved authority and responsibility, accountable autonomy and making sure these RHAs have their budgets and the authority on how to spend it, their not being a legal entity and not being the employer constitutes a problem.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: That is welcomed but does it mean a memo would have to be brought to Cabinet by the Minister if there was a change, which I imagine there would be because it would require new legislation and to be signed off by Cabinet?

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: Regarding corporate function and the memo signed off on by Cabinet, can Mr. Kearns square this with what is in his opening statement? I agree we need a HSE centre to provide governance, clear guidance and consistency. I think we all accept that. We need a lead HSE centre. However, when it states that the HSE centre provides all corporate functions, including all central procurement,...

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I think we are all on the same page. I think Mr. Kearns will find members of the committee agree with everything he is saying. We need people to listen. There needs to be a shift in the mindset in the HSE. I think the Department wants change but there is some resistance from the HSE. I am not saying that some of that is not justified because it wants to provide that central guidance....

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: -----which is the last thing we need. Thousands of organisations are funded by the HSE. We have a complex healthcare system, with voluntary hospitals but also all the section 38 and 39 organisations. The business case here, signed off on by the Cabinet, states the HSE centre will approve all service level agreements, SLAs, with voluntary organisations. I am not sure how this is going to...

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: That is not what it says here in the business case.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: It seems to me, therefore, if we look at the business case, that everything it said and all the concerns we raised have been proven right by the expert group looking at this subject and giving advice. As Mr. Kearns is aware, three models were presented to the Cabinet. Model 1 was no change, while model 3 was much more devolved authority. I think it was somewhere in the middle, at 2.5, and...

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: This model has now been essentially binned, or needs to be binned. This is the message coming from this session, as far as I can see.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: Everything Mr. Kearns has said has suggested this is what needs to be done.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I fully agree.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I wish to come back in on a couple of issues. It was impossible to get everything in in one round. I thank Mr. Kearns for his responses to the first set of questions. If I may focus on capital planning, there is a review of the public spending code or a review of capital from the perspective of the Department of Public Expenditure and Reform ongoing, I think. There is a need for reform in...

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I will put it to Mr. Kearns that we fell into that by accident in budget 2021 when, he might recall, there was an announcement of 1,147 additional acute inpatient beds. In the last year's budget and the budget for the year before that, there were big numbers for additional staff, most of which were not realised. It was never going to be done in one year-----

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: -----but it ended up having to be carried over a number of years. That was, in essence, a form of multi-annual budgeting. It was not designed to be that; it was by accident. Multi-annual budgeting makes sense.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I will ask Mr. Kearns about another issue, that of IT infrastructure, which, as he mentioned, is also important. We understand that the health information Bill will come before the committee in a few weeks. That is very important. I am a great believer in individual health identifiers and centralised referral systems. That now needs to be managed regionally, when we have the RHAs in...

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: Is Mr. Kearns saying it will become a single point of failure? Is that the danger?

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: Interoperability would be-----

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I have two more questions. I will make one overall point on the RHAs. The expression "levelling up" is much misused at present but having RHAs and giving them autonomy could have that levelling up-----

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: -----impact in making sure that those regional disparities that exist are dealt with. We know about the problems in the mid-west, for example, and so on. That will be a big part of how successful or not these RHAs are. How does Mr. Kearns see the role of the National Treatment Purchase Fund, NTPF? How will it interact with RHAs? There is a view, and it is one I share, that there needs...

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: Advice.

Joint Oireachtas Committee on Health: Sláintecare Implementation: Regional Health Areas Advisory Group (26 Oct 2022)

David Cullinane: I will make a final point. Mr. Kearns made the same point in his opening statement and in a private session we had with him and others in the HSE and the Department on RHAs. I mentioned workforce planning as being critical to success. That will be the single biggest challenge in healthcare over the next number of years. We need to be much more ambitious in setting targets for training but...