James Reilly (Dublin North, Fine Gael) | Oireachtas source

I had better conclude, because I must be out of here by 11 a.m. There are a number of issues to be raised about the Irish Nurses and Midwives Organisation's survey. While the Department has not seen the full results and has not had an opportunity to examine it, Deputy Healy in particular made some statements with which I do not agree. He stated the cuts are having serious consequences for the service and I do not accept that. It has had consequences for the service but one cannot argue with the fact that matters have improved. I acknowledge they have not improved to the extent I seek to have them improved but they have improved and that is hard, factual information. The Deputy stated that according to the Irish Nurses and Midwives Organisation, INMO, it has had consequences for the service and I do not accept that either. Its report states it could have consequences, which of course is a possibility, but I have not yet seen precisely what is in the report. Nevertheless, I will make the following points. Some major hospitals in this country have nine nurses per health care assistant, while in other hospitals, the ratio is as low as 2:1. What is that about? While the average number of nurses is higher in the United Kingdom, the average pay of a nurse there is £36,000, or approximately €44,600. However, the average pay of a nurse here is €55,000. There are a lot of issues one must consider this regard. Many community nursing units here struggle to get a ratio of nurses to health care assistants of 1:1 whereas the Royal College of Nursing in London recommends a ratio of nurses to health care assistants of 1:2.5. I accept the nursing organisations have concerns and I expect they always will consider a report from their perspective but there also are other perspectives to be considered.

Deputy Dowds asked whether the figures will stack up and I am pleased he has asked that question for the following reason. Two reports now are available to the Department, namely, the Ogden report, to which Deputy Conway referred, and the PA Consulting Group report. The Department is going to draw up its budgets in a very different way this year than has been the case in previous years. To give members a flavour of some of the things in the Ogden review, it refers to unconventional responsibility at national level in the HSE, in that financial control and reporting lie within a separate portfolio to financial management responsibility at HSE director level. It refers to low levels of professionally-qualified accountants throughout the service, in which it has been estimated that only 10% of staff involved in financial management and control are qualified, whereas in the United Kingdom the figure is 25%. This is the second biggest budget in the State. The report states the core financial management capability of the system must be enhanced and it goes through the issues about which all members are familiar, such as computer systems not talking to one another. According to the findings of PA Consulting Group, the HSE's current budget difficulties are a consequence of systemic failings in financial management over a number of years. Moreover, the operating model remains tied to the previous health board structure and multiple legacy systems are in use, while the systems and processes in place do not deliver an integrated financial performance framework that operates consistently across all regions. This creates inconsistencies in approaches to data collection, analysis and financial performance management and does not support effective consolidation. Furthermore, limited financial management capabilities exist among the staff and the system and where this does exist, it is under significant pressure. The PA Consulting Group report then makes the comment that the Ogden review is the latest of a series of reviews that have highlighted systemic weaknesses in financial management within the HSE since its inception. Members are all aware that because of the budgeting system in place, there really is no incentive for people to stay within budget and when they do so, their savings are taken from them, instead of being left with them to bring about greater innovation in their service. I want to change all that.