I do get a say, yes. But just in part of course, because I only manage a small part of a massive international infrastructure. But, in my company, I manage my piece for the enterprise, so the decisions my team and I make for the technology areas we manage affect all our sites around the globe. Where my efficient organisation differs from the HSE is that there isn't an equivalent of my role in every single office around the world, all getting to make their own decisions on how to address each requirement.
Where did I all say nurses, doctors or cleaners were the issue here, or all staff? It's clearly not all staff, but it's the hundreds of decision makers, the decentralised and duplicated decision making and multiple vested interests all putting themselves before everything else. My wife works in a front line role in one of the major hospitals, I get to hear all her frustration about repeated failures in decision making, purchasing and procurement. Remember the Dail printer scandal? She has multiple similar stories from her hospital alone. She's not in a management role, but is involved in decision making on major contracts because her direct managers who are the decision makers for that service in that hospital have no idea what they're doing, so they delegate and she does it because if she doesn't, they end up with equipment they can't use.
You seem to believe that HSE staff are not making purchasing decisions, who do you think does?