The CEO of the Health Service Executive has he has identified three headline challenges that he wants to respond to in his tenure.
Bernard Gloster, who took up the role two-and-a-half weeks ago, told the Oireachtas Committee on Health that the organisation requires attention and significant change on several fronts in responding to these challenges.
He cited access and performance, timely implementation and public confidence as his main focus.
In answer to Social Democrats TD Róisín Shortall, he said: "We have very good people doing very good jobs, but the centre is too top heavy, there has to be a shift in the power and decision-making."
Mr Gloster said with that change there also needs to be consistency.
"It is an organisation that has become a top-heavy structure with many cumbersome processes. The opportunities presented by Sláintecare and the Programme for Government priorities will assist in tackling some of these issues. But, structure itself, however, is not an answer on its own," he said.
Mr Gloster said he is currently awaiting the results of a staff survey, but one of the things he has heard from staff is that they find the processes very cumbersome and this is one of the things he is hoping to change.
Under questioning from Fine Gael Senator Sean Kyne, Mr Gloster said it is his view that winter plans have passed their usefulness.
"My preference is that we will have an all year-round capacity plan.
"We experience pressures throughout the year and you would find it hard to distinguish between winter and summer. It is something I want to discuss with the Minister [for Health] and the Secretary General," he said.
Mr Gloster also said that there has been growth in recruitment, but the HSE still has significant challenges in terms of retention, not just for nurses but also all disciplines.
He met the Irish Nurses and Midwives Organisation last week in the context of overcrowding at University Hospital Limerick.
He said what is needed is an honest and fair dialogue that "calls out what are the challenges, what are the solutions and out of those what can be responded to now".
Mr Gloster said he has agreed his plan for the Regional Health Authority [RHA] pathways in large part with the Secretary General of the Department of Health and hopes to have it finalised by next week.
"It will include the recruitment of six regional chiefs integrating and running the service. These roles should be in place by 2024," he said.
He told Sinn Féin's David Cullinane that ahead of the establishment of the RHAs, the most important people in the delivery and running of services today are the current hospital CEOs.
As an interim measure, he has arranged to bring the hospital CEOs together on 4 April to take lessons from centres of good management.
Mr Gloster also told the committee that mental health and disability services require series attention at every level.
However, he said the difficulty with recruiting a National Director of Mental health is that moves one part "out of an integrated structure".
Mr Cullinane said that 49 new hospital beds, which were promised by the Government in 2021, will not now be delivered until 2024.
He asked Mr Gloster why it was taking so long to provide the beds.
Mr Gloster said a number of substitute projects are being looked at for those 49 beds.
However, he admitted he cannot "justify or stand over it" and he accepted that four years for implementation is "not timely".
