We are moving on to the fourth and final question from the Regional Group. I call Deputy Cathal Berry.

I wish the Taoiseach a good afternoon.

It is appropriate that we focus on healthcare reform for the day that is in it. There can be no better way of honouring the memory of Vicky Phelan than to focus on and accomplish what she was advocating for, namely, healthcare reform. We want to fix our broken health service to minimise errors and maximise excellence in all its forms. As the Taoiseach and colleagues are aware, I am not interested in HSE bashing in any shape or form. On the contrary, I recognise there are small pockets of excellence all over the health service in every hospital and primary care centre. Our job as legislators is to support these people so we can build on their success. The problems in the health service can be fixed by the good things in the health service, but only if we get our people right. I have three people-related questions for the Taoiseach. People are everything. They are the ultimate precondition to success. If we get our people right, problems melt away, and if we get them wrong, we are chasing our tail for the rest of our days.

The position of chief executive of the HSE has been vacant for some time now since Paul Reid retired or resigned. Where are we with his replacement? Are we likely to get a replacement before Christmas? It is very important we have the corporate governance and accountability in place. We also have 900 consultant vacancies, almost a fifth of the consultant workforce throughout the country. Some positions are unfilled, partially filled or filled by locums. It is very disruptive to the health service. Negotiations on the consultants' contract are ongoing. Are we likely to get agreement on that by Christmas so that we can recruit and retain consultants and ensure appropriate clinical governance and accountability is in place? The new regional health areas, RHAs, are entities designed to streamline the hospital groups and community health organisations, CHOs. Where are we in establishing them? When does the Taoiseach envisage them to be established and made operational to ensure we have the appropriate structural governance and accountability in place? Those are the three questions: regarding the chief executive, the consultants and the RHAs.

I thank the Deputy for raising this issue. It is important in terms of the improvement and enhancement of our health services. It is very much grounded in recruiting expertise and personnel. Since 2020, a net 15,000 personnel have been recruited to the health service, which is the highest ever number recruited in the HSE since its establishment or indeed in the health service. Huge numbers have come in. Obviously, the population is growing. Services are expanding and in many instances are getting better. I was at a stroke centre at the weekend in Cork University Hospital. There are 26 such stroke centres throughout the country. Wherever we get centralisation and a strategic view in terms of a particular disease, great benefits can accrue. Going back to the late 1990s and early 2000s, we had a cardiovascular strategy and the first national cancer strategies, all of which led to improved survival rates. Likewise improvements in stroke care have had a dramatic impact. I would say, in health services overall, having that strategic framework and focus is key, which has to be followed through by implementation. Personnel is key, of course.

The consultants' contract negotiations are progressing in a constructive way between the Minister and team in the Department of Health and the representative bodies. We had a Cabinet subcommittee on health yesterday and we were updated on progress. I would hope that we can bring that to a conclusion as quickly as possible. It is very important we bring clarity to it in line with the expressed wish of most people in this House. That would yield better coverage overall in the health service and better outcomes and treatments for patients.

Work is ongoing on implementation of the regional health areas as outlined in the programme for Government. The Minister brought a memo to Cabinet in April last. An implementation plan will be finalised by the end of the year. The RHAs will have population-based budget allocations and will be responsible for providing health and social care services.

Integration between acute, community and primary care will be key. The recruitment will start early next year for the senior posts and the RHAs will be responsible for recruitment, financial management, service planning and delivery. Transition to RHAs will take place throughout 2023. Funding has been approved in the budget for the appointment of the RHA senior leadership teams and the aim is to have them operational before the end of 2023. If we can bring that forward we will do so but it is a significant structural change from what we have so it will take a bit of time.

The RHAs, in particular, are vital. It is very unusual to have six hospital groups and nine CHOs and for them not even geographically to align so I hope that will streamline the process. It is also reassuring to hear about the consultants' contract. If that can be done by Christmas it would make a massive improvement downstream because you are not just hiring managers or people with clinical governance; you are hiring expertise as well. The old medical adage that prevention is better than cure is an appropriate one. If you get the right people in the right place you can solve problems before they even start, stop mistakes and focus on excellence from there. Hopefully that issue will be solved by Christmas.

It is our wish that we will have this issue solved in advance of that timeline but that is still a matter for the discussions and negotiations. Following agreement we would intend bringing in a new contract hopefully to ramp up the recruitment of more consultants.

On the RHAs, good consultations and engagement with health sector stakeholders have been held and more are scheduled. These include a workshop of the voluntary dialogue forum and six regional events were held for health service workers in Cork, Sligo, Kilkenny Tullamore, Dublin and Limerick in September and October. We are making progress on those fronts.

Before we move on I want to say that it is extremely difficult to chair the debate with the constant interruptions and it must be difficult for the speakers as well. I hate to draw Members' attention to it repeatedly but if phones and various other items could be turned off that would be helpful.