Priority Questions

Charitable and Voluntary Organisations

James Browne


1. Deputy James Browne asked the Minister for Health if, in view of recent events, he has plans to review arrangements for the funding and auditing of section 38 agencies; and if he will make a statement on the matter. [21103/16]

In view of recent events, does the Minister for Health have plans to review the arrangements for the funding and auditing of section 38 agencies? Will he make a statement on the matter?

I thank Deputy Browne for this important and timely question in light of a number of public concerns that have been raised in respect of organisations funded by the Health Service Executive.

I wish to inform the Deputy and the House, as the Tánaiste did some moments ago, that a review of all section 38 providers is being conducted by external consultants. This review is now under way. The purpose of these reviews is to build on some of the measures previously put in place in recent years, to establish the standard of governance in place in these organisations and to confirm independently that the governance practices and procedures accord with those set out in the annual compliance statements of those agencies. These reviews will involve an examination of key governance processes and documents, including obtaining confirmation that internal financial controls and formal written financial procedures are in place in these organisations. Six of these reviews are currently under way. The outcomes of these reviews will inform the HSE's relationship with the agency concerned and any further enhancement that might be required in respect of the HSE's overall governance framework.

The HSE is funding approximately 40 agencies under section 38 of the Health Act as well as providing funding for or grant aid to a far wider group of what we know as section 39 agencies. The size of the 40 agencies delivering services ranges significantly from the Daughters of Charity, with an annual budget of a little over €2 million, to St. James's Hospital, with a budget of almost €357 million. Section 38 agencies have played an important role in the development of our health and social care services. Some agencies delivering services under section 38 arrangements are among the best we have in terms of the quality of care provided and the systems of governance employed. However, there is an absolute requirement for all agencies to review their governance processes continually to ensure these are sufficiently robust. In recent years, the HSE has taken significant steps to enhance its system for performance oversight of section 38 agencies. However, I believe these additional measures, involving an external review and independent oversight, are essential and welcome.

The Minister will be aware of the recent outrage over top-ups to executive salaries at St. John of God hospital. This revelation coincides with news of cutbacks in the services of St. John of God. The HSE maintains it does not consider the St. John of God organisation to be compliant with public pay policy in light of recent disclosures about the remuneration of senior staff. Furthermore, I understand from newspaper reports that talks are under way which may see a number of senior personnel in the National Maternity Hospital being permitted to retain higher salaries. How does the Minister reconcile these reports with those concerning St. John of God? Can the Minister identify which, if any, section 38 organisations are believed to be not complying with Government pay policy? Is the Minister satisfied with the level of policing of pay policy in section 38 organisations in the wake of the top-up scandals? Is the Minister satisfied that all Government requirements are being met by section 38 organisations?

I too am very concerned by what I am seeing in St. John of God. That is why an investigation is now under way by the HSE in respect of those payments. I have been clear, the HSE has been clear and, today, the Minister for Public Expenditure and Reform has been clear in stating that if any payments have been made above and beyond the allowable level of payments, then those payments must be returned. We cannot have a situation whereby some people working in St. John of God are earning salaries lower than that of the chief executive and are subject to the FEMPI Act while people at the very top are earning large salaries and are not subject to it.

That is not fair and is not in accordance with the rules. That investigation is ongoing.

It is not just about whether I can guarantee or I can be assured, it is about whether we have the structures in place to have a degree of certainty. I am not satisfied that we just have an internal HSE review as I want to bring in the external layer. I want independent external consultants to examine all section 38 bodies to ensure they are not just signing on the dotted line to indicate that they are in compliance, but that they are actually in compliance. That body of learning will inform whether we need to take more steps beyond what we are doing.

I welcome that there will be an investigation into the matter and I welcome the confirmation that if there have been any overpayments they will have to be returned. There is a level of disquiet over whether other payments have been made. People will be disconcerted that this specific question cannot be answered. I welcome the announcement of the review, which should be carried out as quickly as possible with any recommendations implemented as quickly as possible so we can ensure that no such overpayments will recur.

I agree with the Deputy. I sat on the Committee of Public Accounts when we discussed this issue back, I think, in 2013. I, like most people on both sides of the House, was repulsed by the carry-on. A number of measures have been implemented in terms of the charity regulator and with new structures in the HSE, but clearly more needs to be done. I do not want and I know no Member of this House wants to see that voluntary sector damaged by bad practice. Some of the best examples of high governance are present in the section 38 bodies. Some of the best examples of care are present in the section 38 bodies. However, any bad behaviour or wrongdoing needs to be weeded out as quickly as possible. I will act on any recommendations. As I said already, six of the 40 reviews are under way. Every section 38 body will be subject to this external review. That is about 40 agencies, which I think is appropriate. It can give all of us reassurance and most importantly it can give the service users, who are often vulnerable people who depend on these services the level of reassurance they deserve.

Home Help Service Data

Louise O'Reilly


2. Deputy Louise O'Reilly asked the Minister for Health the number of banked and paid for hours that home-help workers are due; the breakdown of these by region; the number of hours that have been cut from persons in the same areas for the period 2014 to 2016 to date; the number of home-help hours projected for 2016 and the percentage of these that have been delivered to date; and if he will make a statement on the matter. [21095/16]

This question relates to home-help services. I had the privilege and pleasure of representing home helps during the negotiations for the contract to which the question relates. The purpose of the contract was to ensure they would have stability of hours with a certain degree of flexibility built in. According to reports in the media, from which, disappointingly, we are getting a lot of information about the health service, these hours have now been banked and remain unused. The purpose of the question is to investigate what is going on there.

I thank the Deputy for her question. As she rightly pointed out, she was part of a process that took place in April 2014. Following the Labour Court recommendations, the HSE implemented the new contracts for HSE home-help staff with the agreement of SIPTU.

At the end of April 2016, 33% of the target of 10.4 million home-help hours set in the HSE's national service plan had been delivered.

The HSE and SIPTU agreed a revised contract for those providing home help to be operational from April 2014 under the auspices of the Labour Court. This provides that the relevant employees are paid in full for their contracted hours. However, where the hours they actually work drop below this, usually because of the changing needs of those in receipt of the service, the difference in hours, as the Deputy rightly pointed out, is banked on the understanding it will be worked at a later stage.

This concept of banked hours is subject to quarterly review to ensure that excessive banked hours do not build up. That normally comes into play when there are more than 100 hours. Of the 6,900 part-time workers providing home help in January 2016, 67 workers, mainly in Cork and Kerry, had banked 100 hours or more. In these cases, steps are taken to reduce the build-up, including by working relief for other home-help workers. Contracted hours can be reduced for various reasons, including the preference of individual workers, availability of transport and the need for particular skills. As reductions in contract hours for individual home helps are not collated nationally, unfortunately, I will not be able to give the Deputy some of the figures she has requested.

The HSE will continue to work to apply available resources to most effectively target those with the greatest need and to provide the best possible contribution to the system as a whole. Home-support services are provided on the basis of assessed health-care need and regularly reviewed. Services are being stretched by demands from more people, and for more hours at times outside of core hours, in the evenings and at weekends, all of which cost more. I am happy to say that the Government has been able to respond to this by providing an extra €40 million for home care in 2016. Not only will this ensure that the home-support services provided in 2015 are maintained but it will also ensure they are increased.

That was a comprehensive answer to a question I did not ask the Minister of State. I asked for specific details about the number of banked hours. She told me of about 67 people in the Cork and Kerry region who had banked 100 hours or more. How many hours are banked in the system?

I do not think any Deputy in the House would dispute Sinn Féin's position on the matter. We are contacted on a daily basis by people who are very concerned because an elderly relative, a young sick relative or a relative confined to home for any reason is having home-help hours cut. The HSE is cutting the hours to the vulnerable and those who need it the most while at the same time banking the hours of people who want to work. It is also effectively cutting back on those hours. I have asked a fairly simple question and I would appreciate if the Minister of State could answer it directly.

As I mentioned to the Deputy, the information is available locally but has not been collated nationally. That is something the HSE has not done and it believes it would not be possible to allocate the resources to collate those data.

There are a number of reasons for reducing home-help hours. Sometimes it is down to the individual carer for various reasons. In other cases it is due to shortage of funding. We have increased the funding by €40 million for this year, which means that the new base for next year will be €371 million, up from €331 million. As we increase the funding going into home help and home-care packages, that slack will be available for the home-care workers to take up. Unfortunately, I do not have the data the Deputy has requested. It is not accessible to the HSE at the moment, but it is available locally. If the Deputy has any specific local case, she could bring that to me and I could get the information on it.

Specifically, every local figure is required. I have brought that to the Minister of State now and perhaps she could come back to me with the answer.

Some people are put to the pin of their collar now because their home-help services are being cut. The only reviews that happen are reviews with a view to downgrading services. The evidence of people who attend my clinics and those held by my colleagues supports that. The Minister of State has not provided any evidence to dispute it.

Does the Minister of State accept there is a crisis with home-help funding and home-help hours? While the HSE is busy banking hours, some people desperately need those hours, which should be provided. The Department should issue an instruction to the HSE to use all available hours, especially those hours that have been paid for.

Every hour that is available will be used up. All funding that has been allocated for home help and home-care packages will be used up. The 2016 national service plan provides for 10.4 million home-help hours. Home-care packages are measured separately but we need to move towards measuring them in the same way.

On the question of home-care packages, we will be moving from 15,450 people to approximately 21,000 people because of the additional funding that has been provided this year. If we start next year from a higher base and continue to increase it, as we have promised in our programme for partnership Government, then those figures will increase further. It is a major priority for me and is a priority for the Department. We will continue to increase the funding and increase the support services. That will also help the workers.

Services for People with Disabilities

Margaret Murphy O'Mahony


3. Deputy Margaret Murphy O'Mahony asked the Minister for Health when the task force for the implementation of personalised budgets for persons with disabilities will be established; and if he will make a statement on the matter. [21104/16]

I thank the Minister of State, Deputy Finian McGrath, for his co-operation on my portfolio so far. As I said previously, I look forward to working further with him. When will the task force for the implementation of personalised budgets be established? I ask him to make a statement on the matter.

I thank Deputy Margaret Murphy O'Mahony for her comments. I will work with all Opposition Members to improve services for people with physical and intellectual disabilities.

The establishment of a task force on personalised budgets is a key element of the commitment in the programme for Government to give people with disabilities greater control, independence and choice.

Personalised budgets transfer control back to the individual and give him or her the freedom to source the services and supports which best meet his or her needs. While the concept of personalised budgets is not limited to health and personal social services, my view is that the task force should concentrate on personalised budgets for services for people with disabilities funded by the HSE in the first instance. Some work has commenced on scoping how to introduce individualised budgets in health-funded disability services as part of the Transforming Lives reform programme. The task force will build on this work.

I am committed to setting up the task force as soon as possible. I am in the process of finalising my plans in that regard. I intend to inform the Government of my decision on who will chair the task force by the end of this month. I also intend to outline to the Government on that occasion my plans for the appointment of members of the task force and the development of terms of reference, objectives, scope and key deliverables. With the support of the Government, I will then proceed to appoint members and arrange for the first meeting as soon as practicable. Some of the groundwork in this regard has commenced. I have set myself clear targets. I have said this is one of the projects I want to be set up and to be up and running within 100 days of taking office. I think we have been in office for approximately 67 days. We are on target to get the project up and running. I will come back later with more details in this respect.

I thank the Minister of State for his reply. I am still looking for an exact date for the establishment of the task force. We were told in the programme for Government that the Government would "establish a Taskforce within 3 months". That will bring us into August. I wonder whether it will be possible for the task force to be set up when the House is in recess. I know that the Minister of State has very good intentions, but it is not good enough for him to say this will be done "as soon as possible". People need an exact date.

Will the Minister of State tell us whether the committee will cross the Departments of Health, Social Protection and Justice and Equality? The Minister of State mentioned the terms of reference, which will be very important.

I have decided to appoint a chairperson and have a person in mind. I will announce that person's name in a matter of days. The Government will be informed of my plans for the appointment of the chairperson and the composition of the task force by 26 July next. That is the date I have set for myself. The Deputy is right when she says we cannot let this go into August. I am working on a memorandum for Government to be presented at the last Cabinet meeting before the summer recess. On that occasion, I will outline to the Government my plans for the membership and the secretariat of the task force and for the development of terms of reference. This will be followed as soon as practicable by the appointment of the members of the task force and the making of arrangements for its first meeting. The direct answer to the Deputy is that 26 July is my short-term target. I want to have the task force up and running by the end of the month.

I thank the Minister of State for giving me a definite date. I will watch every move to make sure this happens.

I know that the Deputy will do so.

It has been reported that the Minister of State has said a "seismic shift" is needed in how disability services are provided and funded. Will he confirm that is what he said? What did he mean by it? I presume the one-size-fits-all approach is not going to work anymore. A great deal of money is being allocated to service providers. I suggest it be given to individuals and community-based projects. I ask the Minister of State to comment on this.

I can confirm that there will be a seismic shift as we reform the services provided for people with disabilities. I am pushing forward a strong reform agenda. The key issue for me is that the entire plan for disability services will be centred on the person with the disability, regardless of whether he or she has an intellectual or a physical disability. I want to change the mindset in Irish society to one of respect for citizens of the State. Over 600,000 people either have a disability or are in the family of a person with a disability. As members of society, the people concerned pay their taxes, just like everybody else, and have to be guaranteed services.

On the issue of individualised budgets, I will engage with civic society to build an evidence base, gather data, research international experience and identify available options. I emphasise that parents and families will have a choice in this regard. We will not force any parent to accept an individualised plan. Some parents might have different ideas. The key point for us is to invest in and reform services and ensure money is spent on services. In recent weeks we have seen other instances in which public moneys have been wasted.

Charitable and Voluntary Organisations

Alan Kelly


4. Deputy Alan Kelly asked the Minister for Health to provide an up-to-date list of section 38 entities which receive funding from the HSE and the amount of funding each organisation received from 2013 to 2015, inclusive; if he will publish all HSE audits of section 38 organisations; and if he will consider a policy of seeking to ensure a representative of the HSE serves on the board of each of these entities on at least a pro tem basis to ensure transparency and public confidence in the spending of public money. [21096/16]

I have just left my office after reading some very worrying documentation related to the HSE and a section 39 organisation that will be discussed on Friday at the Committee of Public Accounts, of which I am Vice Chairman. There is a crisis in the transparency of funding organisations under sections 38 and 39. I listened to the Minister's response to Deputy John Browne and the Tánaiste's response to my party leader earlier. To be honest, they did not fill me with confidence on these issues. I ask the Minister to publish the audits of all section 38 organisations in a spirit of transparency. Will he consider pro tem putting a representative of the HSE on the board of each of the organisations, or asking the organisations to do so, to ensure public confidence in the spending of money?

I congratulate the Deputy on his election as Vice Chairman of the Committee of Public Accounts. I have previously served on that fine body and know that the Deputy will have an interesting day on Friday. I have read the same documentation he has read on a certain organisation. It is very disturbing and disgusting in parts.

I have received a breakdown of the funding received by the 40 section 38 agencies from the HSE. I will supply this information to the Deputy in tabular format. It would not be possible to read all of it the House. The total funding for these agencies was €2.735 billion in 2013, €2.747 billion in 2014 and €2.883 billion in 2015. As I said to Deputy John Browne, the annual grants provided for these agencies range from €2.05 million in the case of the Daughters of Charity to €356.87 million in the case of St. James's Hospital.

Under its establishing legislation, the HSE is responsible for financial and performance oversight of agencies funded under sections 38 and 39 of the Health Act 2004. The HSE has a formal national governance framework within which such funding relationships are managed. As part of this governance framework, the HSE requires all grant-aided non-statutory agencies to submit their annual audited accounts to it. Furthermore, as part of its annual audit plans, the internal audit division of the HSE conducts audits of a number of agencies each year. Several audits are in progress. The documentation the Deputy was reading before he came into the Chamber, which has been referred to in the media, was the subject of an internal HSE audit. Such audits generally focus on the systems of internal controls operated by the funded agencies and compliance with the HSE service level agreement.

In addition, a number of internal audits have been conducted of the HSE’s management processes and controls in the funding and monitoring of services provided by the non-statutory agencies. When these internal audit reports are fully concluded, they are sent to the Comptroller and Auditor General and routinely issued under freedom of information legislation. I want to look at publishing all of them, as the Deputy has called on me to do. However, I do not want to bring about an inadvertent delay in finalising an audit as a result of requiring it to be published automatically. I want to work with the Deputy and his colleagues to try to get this done. As I outlined to Deputy John Browne and as the Tánaiste outlined, it is not good enough merely to have an internal look at this matter. We also need to have an external look at it in order that we can ascertain how many lessons have been learned and how many recommendations have been made. That is why we have brought in external consultants.

The following revision was received from the Department on 20 Juy 2016

The Reply at that time indicated that there were 40 Section 38 agencies. This was incorrect; there are 39 section 38 agencies. Annual funding to these agencies ranges between €1.7 million to Cork University Dental School and Hospital and €361.4 million to St James’ Hospital. Total funding allocated by the HSE in each year to those agencies was €2.69 billion, €2.7 billion and €2.84 billion respectively.




Total Grants

Total Grants

Total Grants

No #

Name of Agency





Beaumont Hospital





Brothers of Charity





Cappagh National Orthopaedic Hospital





Carriglea Cairde Services Ltd





Central Remedial Clinic





Cheeverstown House Ltd





Childrens Sunshine Home (Laura Lynn Children's Hospice)





Coombe Women's Hospital





COPE Foundation





Cork University Dental School and Hospital





Daughters of Charity





Dublin Dental Hospital





Incorporated Orthopaedic Hospital of Ireland, Clontarf





KARE, Newbridge





Leopardstown Park Hospital





Mater Misericordiae University Hospital Ltd





Mercy University Hospital, Cork





Muiriosa Foundation





National Maternity Hospital





National Rehabilitation Hospital





Our Lady's Children's Hospital, Crumlin





Our Lady's Hospice & Care Services (Sisters of Charity)





Peamount Hospital





Rotunda Hospital





Royal Hospital Donnybrook





Royal Victoria Eye and Ear Hospital





South Infirmary Victoria University Hospital





St James' Hospital





St John of God Services





St Johns Hospital, Limerick





St Michael’s Hospital, Dun Laoghaire





St Michael’s House Group





St Patrick's Centre, Kilkenny (Sisters of Charity)





St Vincent's Hospital Fairview





St Vincent's University Hospital, Elm Park





Stewart's Care Ltd





Sunbeam House Services





Tallaght (Adelaide and Meath) Hospital





Temple Street Children's University Hospital




Total Grants to S38 Agencies







Total Grants to Outside Agencies per AFS




S38 as a percentage (%) of Total




I thank the Minister for his reply and look forward to the provision of the documentation. I remind him that I asked a considerable number of questions as part of the Estimates process. A number of weeks have passed and I have yet to receive any response. I hope this question will be answered within the timeline suggested by the Minister.

The supervision of the agencies in question is a source of significant public concern. The Minister has not answered the question I asked. The public is rightly concerned about this issue. Everybody in the House is aware of the level of public concern. If an organisation such as Console can get away with what it got away with, even though it was receiving such a volume of funding, we must look at the incredible volume of funding being received by many other organisations.

They do fantastic work but we must ensure there is public confidence. I am happy that, as the Minister says, the audits will be published as quickly as possible but what about pro tem? The Minister said earlier in response to a question that he wished to ensure that there are established practices of governance. That does not fill me with confidence that the current practices in place work. Can we ensure somebody is put on the boards of these 40 organisations pro tem or have some type of relationship to ensure public confidence?

While I am endeavouring to fill the Deputy with confidence, we must be careful not to fill Irish people with a lack of confidence in some of the best service providers we have in this country in the delivery of health care. Some of the section 38 organisations, in fact many of them, are operating to the highest governance standards-----

-----and are delivering vital health services which, frankly, were never delivered by the State. If they were not there, God knows what type of situation vulnerable people in this country would have found themselves in. What we must do is take out the bad apples. We must find the people who are not living within the rules. That is the reason we have an annual compliance statement. What is particularly upsetting and disturbing is that people in some cases are signing on the dotted line to say they are in compliance and that they are living within the pay structures, when they simply are not. That is the purpose of the external review and the internal audit. It is the reason for sending the internal audits to the Comptroller and Auditor General.

On the question about pro tem, I have examined this and I do not believe it works. The reason is that when I was a member of the Committee of Public Accounts, we had representatives of the Dublin Docklands Development Authority, DDDA, appear before the committee to discuss that debacle. The Department of the Environment, Community and Local Government had a representative on the board of the DDDA. The committee also had representatives of the Red Cross appear before it. The Department of Defence had a representative on the board of the Red Cross. The issue is that roles and responsibilities got extraordinarily confused. I believe there are inadvertent consequences. Who is the person responsible to - the board or the HSE? I prefer to beef up these controls first.

Hospital Groups

Jack Chambers


5. Deputy Jack Chambers asked the Minister for Health the criteria for appointment to senior hospital management positions and for board appointments in each of the hospital groups; and if he will make a statement on the matter. [21105/16]

My question is about the criteria for appointment to senior hospital management positions and for board appointments in each of the hospital groups. What is the process? Are all of the senior executive positions within the groups publicly advertised, with interviews? Are all board appointments in the hospital groups publicly advertised?

As I have stated previously, I intend to continue to implement hospital groups structures but on an administrative basis. The reason is that I asked the House to establish an Oireachtas all-party committee to develop a single long-term vision for health care over a ten year period. It is important that those discussions are progressed before I give further consideration to the issue of establishing hospital groups on a legislative basis. It would be disingenuous to move ahead with that while the committee is doing its work.

With regard to senior hospital management positions, the HSE has developed eligibility criteria for senior management posts at hospital group and individual HSE hospital level. The criteria reflect the particular experience, knowledge and qualifications required for specific posts and public sector recruitment policies apply to the filling of such posts.

Regarding the hospital group board appointments, chairs are in place for all hospital groups and board members were appointed to three out of seven hospital groups - Saolta university health care group, UL hospitals group and the children’s hospital group.

The terms of office of the Saolta university health care group and the UL hospitals group boards are due to expire shortly. Given the scale of the change process involved in implementing hospital groups, the hospital group boards must be populated with individuals with the expertise and competencies necessary to deliver on the strategic and change management agenda.

My Department will shortly advertise, through the Public Appointments Service process, for nominees to all of the hospital group boards, excluding the children's hospital group, and I expect to be in a position to populate all of those boards fully in the autumn, around the end of September. All of those board appointments will be carried out through the Public Appointments Service. It is important to do it that way for transparency. There is benefit in populating the boards, even on an administrative basis. There is a body of work to be done in terms of strategic planning for the hospital groups and the areas that could benefit from it. I intend to populate the boards and to use the Public Appointments Service to do it.

I asked the Minister about the process for appointments. He outlined eligibility criteria but he did not outline a transparent process. We are seeing a complete replication of the same management that was previously in hospitals in senior executive and chief executive management positions in the hospital groups. I will offer some examples. One CEO of a group was previously a CEO of a main hospital. That person then became an executive of the HSE after which the person became the chief executive officer of the group. Another was a director of nursing at a large hospital. The person became the acting CEO of a hospital, then became the de facto CEO of the hospital and is now the CEO of the hospital group. Another person was deputy CEO of a hospital who then became CEO of another hospital. Guess what, a Cheann Comhairle? That person is now the CEO of a hospital group. Where is the transparency around the appointments to these hospital groups? It is a very important process of reform. Apart from mentioning eligibility criteria, the Minister has not outlined how this Government or the previous Government delivered a transparent process of recruitment for the management of the hospital groups. The Minister must clarify the matter.

I am accountable to the House for the decisions I have made during my time as Minister for Health. That is what I was endeavouring to do in my initial response to the question, by outlining my philosophy and principal objective in how I intend to populate the hospital group boards which are not currently populated. I assure the House that nobody will sit on a hospital group board or be appointed by me to such a board who has not come through the public appointments system. That is important.

However, the Deputy raises a valid point relating to the appointment of senior hospital positions. The Deputy is probably aware of the history of this. There was a Government decision on 14 May 2013 on the reorganisation of public hospitals into hospital groups. Sanction for that was conveyed to the HSE in July 2013. There was an urgent request from the HSE in August 2014 to reassign senior managers from within the health service to the hospital group CEO posts. That was done on the grounds of exceptional circumstances and with the agreement of the Department of Public Expenditure and Reform. It was also done on the basis that these proposals would not result in any additional senior posts within the health service, considering the financial situation of the country. The Department also agreed that the individuals would be assigned to these posts for a period of up to 24 months in the first instance, so this issue will arise again and it will be up to me to develop policy for how we wish to move forward.

The Minister mentioned exceptional circumstances but the issue is that the same chief executives have become chief executives of the groups. Their positions in the hospitals must be filled so a hospital senior executive manager has to move from another place. We are seeing a de facto locum system for managers in our health service. It is a managerial merry-go-round. It is a cosy cartel, with insiders in senior executive hospital positions rotating. If we ran our hospitals in the same way as the managers are moving around, we would be in complete chaos. It is the equivalent of consultants or senior clinicians rotating around the different hospitals every year, so they cannot implement change management. We have a system of managers changing but no strategic change within our health service. I urge the Minister to investigate the rotation of managers within senior executive positions in the health service. It is not transparent, despite the exceptional circumstances. I do not accept the point about the eligibility criteria. I urge the Minister to deal with this matter soon.

I take the Deputy's point but I reiterate my point that these appointments were made for a 24-month period. We did not have a scenario whereby people were sanctioned for the rest of their career. These appointments were made initially for 24 months, considering what the then Government decided was the particular and extraordinary circumstance of trying to get these hospital groups up and running. There is a serious issue in the Irish health service, however, in terms of ensuring we can attract and retain the appropriate level of management and clinician we want. I would appreciate it if the all-party committee on the ten year plan would examine that. I am meeting hospital managers and hospital group CEOs at present and I am looking into the whites of their eyes and saying, "I need you to live within your budget" or "I need you to do this on patient safety". I need to know that we have the calibre of people that is required and I do not mean this in any disrespectful way to the people currently doing their jobs. However, the Deputy will be aware that there was difficulty in managing to find people to apply for the posts and certainly in finding anybody to agree to take up the posts. These were the circumstances in which these individuals stepped up to the plate. They are doing their best and, in many cases, are doing a good job. It is for a 24-month period, after which it will be reviewed.