The resignations of Professor Tom Keane, chair of the Sláintecare advisory committee, and Laura Magahy, executive director of the Sláintecare programme, to reshape the health service have now been followed by the resignation of Professor Geraldine McCarthy, chair of the South/South West Hospital Group, who in a letter to the Minister for Health, Deputy Stephen Donnelly, expressed concerns about the lack of progress in implementing Sláintecare reforms. These developments may be followed up by further resignations from the advisory committee, which has been left in the dark regarding what is going on and the reasons for the resignation of Professor Keane. Liam Doran was on the radio yesterday morning expressing those concerns.

One does not have to be a genius to see there are serious frustrations among those tasked with overseeing the Sláintecare reforms. It seems to be the case that this crisis is as the result of opposition at the top of the HSE to the creation of six new regional health bodies, which would result in the devolution of powers from the executive. The regionalisation of services is essential to Sláintecare and the integration of hospital and community healthcare and to respond to the financial public health needs in the regions but Paul Reid, who runs the HSE, stated last year that regionalisation was not a priority and it seems the Minister agrees.

I was a member of the Dáil committee, along with the Minister, that produced the Sláintecare report. It was well understood by the committee that the proposed reforms, in reality a revolution in how our healthcare would be delivered, would meet with serious opposition whether from the Department of Health, the HSE, elements among the medical profession and the numerous vested interests in private healthcare. That is why two key recommendations dealing with the implementation of Sláintecare were included in the report. One was that the implementation oversight body would not be placed in the Department of Health but in the Taoiseach's office and, second, that there would be special funding of €600 million a year for five years to support its work.

In 2017, when the Government, of which Deputy Varadkar was the Taoiseach, accepted the Sláintecare programme, neither of these two recommendations were implemented. The oversight body was placed in the Department of Health and no specific funding was allocated. I believe this was done deliberately. The political commitment to implement Sláintecare as envisioned by the committee report was simply not there and still is not. Dr. Michael Harty, in 2019, came into the House on Leaders’ Questions and explained very succinctly why Sláintecare was not being implemented properly.

Does the Tánaiste agree that what needs to be done now is to move the implementation body to the Department of the Taoiseach immediately? The Taoiseach's statement that the Department does not have the staff to run the health service is ridiculous. Nobody is asking it to do that. It is about giving the implementation body the clout of the Taoiseach's office to deal effectively with opposition.

I thank the Deputy. I want to add to the words of others in expressing my regret at the fact Professor Tom Keane has stepped down as chair of the Sláintecare committee, albeit six weeks before his term was due to end. I met him in Ireland and in Toronto. He is a fine man and I am sorry he is no longer part of this project. Obviously, I regret the fact Laura Magahy has resigned as the programme director.

I think it is important, though, to set out some facts. In contrast to what the Deputy said earlier, €1.235 billion - that is €1,235 million - was allocated to Sláintecare initiatives in 2021, that is this year. I am reminded of Laura Magahy's positive comments to the Oireachtas after the previous budget in respect of the funding delivered by Government to the programme. In her own words, she recognised that €1.2 billion was provided for Sláintecare initiatives this year by this Government. In the most recent progress report on the first six months of the new Sláintecare implementation strategy, the report, which was produced by Ms Magahy, shows that of the 112 deliverables in the first six months, 84 were on track, 25 were in progress with minor challenges and three were experiencing major challenges. Out of 112, 85 are on track, 25 getting there and three behind. This is not my opinion. This is the opinion of the former director herself - €1.2 billion and the vast majority of actions on track - and I think it is important to put that on the record.

A lot has been done on health reform in the past year or so. More than 800 beds were added to our hospital system, the equivalent of two medium-sized hospitals being added to the system, which is extraordinary, with 6,000 more staff, 250 more consultants, thousands more nurses and midwives, an increase in our critical care bed capacity of nearly 50, which is extraordinary when you understand the depth of that, GP access to diagnostics, e-prescribing, something which was talked about forever and is now a reality, remote and virtual clinics and a dramatic reduction in the waiting lists for home care. If anyone is suggesting that reforms have not happened, money has not been spent and progress has not been made, that would be very untrue and very unfair, in my view.

In regard to the RICOs, regional integrated care organisations, something I very much support, establishing them is Government policy to slim the HSE at the centre and to establish more regional autonomy. The Government agreed to that in 2019 but, in fairness to the HSE, since that was signed off by Government, and it was in recent weeks or months of the previous Government, we have had a pandemic, we have had a cyberattack and we have had people working from home. Anyone who has been involved in restructuring an organisation knows how difficult it would have been to proceed with establishing new structures when people are not even in the office and they are working from home in many cases, unable to reapply for new jobs, interviews, redundancy schemes and all those complicated things that have to be put together when we do restructuring. Even leaving aside those difficulties, it had a cyberattack which crippled its services for months and it had to deal with a pandemic. I think the HSE has done a fabulous job in this pandemic in so many aspects of what has been done.

I do not think anyone should point the finger at staff. What Covid- 19 has demonstrated is how universal public healthcare can be delivered from the point of view of access for everybody to public healthcare, to vaccinations, to PCR testing, to GPs and to hospital care. That is not in question here. However, that Covid care is a model for how Sláintecare has to be implemented. Covid-19 was pushed by Government and politically driven. We had an advisory group, NPHET, and we had staff willing and able to put themselves upfront to deliver on those services. That is we have to see in Sláintecare but we have not seen that.

The Tánaiste said that the money was put in, and it was €1.2 billion in 2019 or 2020, but Sláintecare specifically states €600 million a year, starting in 2018, and that it must be in the Taoiseach's office to deliver it politically. That is where we are lacking, but we do not really know because we have not been able to find out why Laura Magahy or Tom Keane resigned. I know the Minister is meeting Laura Magahy. Are the Tánaiste and the Taoiseach going to meet these people to find out what went wrong and then implement what they need to drive the programme forward? We will not get two better people to do this and it is a shame they are gone.

I thank the Deputy. I understand the Taoiseach is going to meet them and the Minister for Health has or is about to meet with the advisory council. I am not pointing any fingers here. The Deputy is the one who has been pointing fingers. I do agree with her that Covid care is a very good example of how we can run a health service well in the future. What she may not know, or may not wish to acknowledge, is that a huge amount of what has been done on Covid care in the past year or two has been done in the form of a public-private partnership, with a large degree of outsourcing: private contractors, private hospitals, GPs who are private contractors providing these services, private labs and private recruitment services that were used to bypass the cumbersome public systems that slow down recruitment.

All backed by public money.

If what we have done in terms of our response to Covid in the past year or so is a success, and the Deputy has acknowledged it is, I think she needs to perhaps consider why it worked so well, why it was done so quickly and why it was able to stay on budget.