Jack Chambers (Dublin West, Fianna Fail) | Oireachtas source

Could I get an update on the budgetary allocation for the children's hospital? Has that capital allocation for that changed in the Estimates?

On one level of the Sláintecare implementation strategy, the Minister of State has said there will be a complete split between public and private care, but on another level he has said there will be a problem in terms of a shortfall. There seems to be a perverse incentive whereby public hospitals are reliant on the private income which they are due to lose, but the Government's policy is to remove the private income. What is the weaning phase and the plan for private care in public hospitals under the Sláintecare plan? The Department's position is that there is reliance on private income for public hospitals but then the ambitions for Sláintecare will not be achieved. I would like to hear the thoughts of the Minister of State in that regard.

I respect the fact the Minister of State wants to give a position in terms of management, but instead of saying it is an old political chestnut and an opportunistic comment he should acknowledge there is a problem. The Chairman mentioned it. Everyone working in healthcare gives feedback to us, and I am sure to the Minister of State, that there is an issue. In OECD terms we have one of the highest spends but our level of front-line output is probably below average. We have a mismatch and it is not due to a lack of investment or will on behalf of the Minister of State. We have a lot of people in management that are not managing the budgetary allocation. As Deputy Durkan mentioned, while the Minister of State talks about accountability and transparency, we are not getting accountability from anyone. We cannot even identify who the managers are and how they are matching their targets because there are so many of them. If eight people are responsible for a particular segment of a care pathway or delivery in a particular hospital, they are not accountable. What tends to happen is that people get promoted out of their positions and they are rewarded for not necessarily delivering on their own service plans within the healthcare system. Anyone in the Department, including the Minister of State, needs to build that into the promotion system for managers. I am trying to be constructive. I am not trying to raise an old political chestnut. This is a significant issue and we will never have any progress in Sláintecare if we continue to allow the layers of management to grow. It is not the fault of the Government. The system has been in place for 20 years. All parties have had an input into the Department in those years. I do not lay the blame at the door of the Minister of State but, politically, we need to grapple with it. Hospital groups were created in recent years and there was a change in Government policy to get rid of them and to replace them with a Sláintecare structure. We have spent a number of years layering up hospital groups and now we are transitioning into another structure. I am concerned that we are going to add additional layers because that is always a risk when an organisation transitions. That is the lesson from the HSE. The layers grew when we went from having health boards to the HSE. I hope that we have learnt the lessons from that.