I thank the committee for the invitation to appear before it. I will give the committee an update of the activities of the last few months since we commenced in the middle of January. I will also provide an update of the activities of the Health Service Executive and the steering committee.
The committee will know better than I that our road map is the Cabinet decision in this area and the three reports, Prospectus, Brennan and Hanly. In September the Department, with a number of people from the health service, formed a number of groups and approximately 13 projects. A composite document was the result. That is the road map with which we now work.
In the initial stages I spent six to eight weeks on the road talking to people on the ground to get a sense of what they thought of the reforms. I wanted to form a practical view of their views on how reforms might be implemented from the point of view of service delivery. I came to a clear view on two things. If these reforms are to be implemented then the people on the ground must be involved, it cannot be driven by management consultants. It is now about to go live and it is the people in the service who must have the say on how these reforms are to be implemented in the most practical way.
We have developed what I call three tenets for testing each aspect of the reform on the ground. If something does not meet up to these tenets, we will go back again and again. The three tenets will not happen immediately but taking a medium-term view, what is put in place must improve the patient-client journey; from the point of view of staff it must create a better, more challenging and encouraging environment and from the point of view of the State, the large amount of money being invested in the health service must be seen to deliver value for money. These are the three tenets in which we passionately believe. Everything we do is being measured against them.
We have assembled a change management team. The team comprises people from all over the service, from the medical and nursing areas and from the health boards. They have been seconded to the executive until the end of the year and will then return to their original work. They number approximately 30 people and they have been divided into three or four groupings. One is to focus on the composition of the national health office, a second is to focus on the primary community and continuing care area, the third will focus on shared services and the fourth on the issue of communications. I will return to that because it is emerging as a big issue.
Stages have been set as we proceed towards the end of the year, when the HSE goes live, and at which there will be deliverables in terms of the practicality of implementing these reforms. The work of the team is to talk to people on the ground. They are examining the system from bottom up and top down to ensure that what is put in place in January will, over time, meet the three tenets I have outlined. If something looks as if it will not improve the situation, we will take a fresh look and tease it out further.
One of the issues about which there is much uncertainty and concern is the question of the four regions, how they will be split and where the head office for each region will be located. One of the project groups to which I referred produced a draft paper on the region and the criteria it used seem sensible. Although it is creating much uncertainty in the system, our view is that it will be too early to make a decision on this until we test its recommendations against what we see as the best method of service delivery. Work is still under way on this issue and we hope to have clarity within the next couple of months.
We also formed a separate group in the area of information and communications technology. It is very clear that the health service suffers from a serious lack of investment in technology. I regard it as fundamental to improving services to patients and clients. Much work has been done and there are significant proposals in the pipeline. However, we want to step back and validate these proposals over the next month or two. At the heart of the matter is the wish to put in place a system whereby all instances of patients or clients coming into the primary or acute sectors will be captured technologically. Consequently, all the voluminous paperwork that is now required will no longer be necessary and staff will be freed up to focus more on the key issue of delivering a better service.
Communications is a major issue. Up to 100,000 people will be employed by the HSE on 1 January. As the committee knows, there is considerable insecurity and uncertainty. We have been devoting considerable time in recent months to talking to people and obtaining their views on the reforms and the best way to implement them. We do not have all the answers but we are engaging with the people. The current state of technology and the large number of people concerned are such that it is hard to communicate with them speedily on what we are doing. We have made a commitment to engage with everybody and we will be relentless in this regard. I consider this to be fundamental.
The amount of change taking place is leading to much uncertainty. I believe very strongly in having proper consultative dialogue with staff representatives. We have met the Health Services National Partnership Forum a few times, with which we are working to draw up a protocol on the type of dialogue we will have as we become clear on how the changes will be implemented. I have also met a large number of the unions and we have had positive dialogue. We regard consultation and partnership as critical in bringing about these changes, and we are putting work into this area.
Since the HSE must be live on 1 January, we have advertised for the position of chief executive. Also, while one would normally allow a chief executive to appoint his or her own management team, the deadline is so tight that we must also appoint the next layer of management. We are having discussions with the Department of Finance on grading and other issues. We will be advertising the next layer in the coming weeks. The positions will include director of the national hospitals office, director of primary, community and continuing care, director of shared services, director of information technology and director of human resources. We are trying to establish exactly what kinds of posts we will have on the medical side.
The board of the executive has met twice. It is very enthusiastic, committed and interested and we will have a further meeting in the next week or two.
The national steering committee has had one meeting and we are planning to hold another soon. The role of the steering committee, as this committee knows only too well, is to pull together all the various reforms. We are working on streamlining the agencies, setting up the health information quality authority, the reorganisation of the Department of Health and Children - the changes will have a significant impact on the Department also - the implementation of the Hanly recommendations and the question of the medical contract. We are in debate with the Department on the question of legislation. The legislation is fundamental because, if it is not in place, its absence will be a show-stopper on 1 January. On the changed management team to which I referred, we are now engaging with the Department in all these areas and are working with it in partnership. The Hanly report is obviously on hold because of the discussions about the contract. Once the negotiations on the contract are under way, we intend to have representation on the negotiating team.
The programme of change is extraordinarily complex. The Minister has described it as the largest change programme in the history of the State. On 1 January, there will be a streamlining of structures and this will lead to a much better focus on service delivery. However, this is only one side of the equation. It cannot be a question of structures alone. The medical side, whether primary or acute, must also be streamlined from the point of view of the patient. It must work in partnership. As we work through the year, I hope we develop a better partnership on both fronts. That is the current position and we will be glad to deal with questions.