Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome Mr. Doran's comments on the Haddington Road agreement. The agreement provides that all staff must work two additional hours per week. What is the best way to implement this change, not only in the context of the impact on INMO members but also with regard to the impact on patients, outcomes and productivity? If two additional hours were done every week in, say, 20-minute slots, as opposed to a system under which everyone works an additional day every now and again, better outcomes would probably be achieved in respect of health services and productivity, but it would have an impact on INMO members. What are Mr. Doran's views on how best to implement the additional hours? We have to accept that the Government is limited in the amount it can put into health services. As an Opposition Member, I would like more money to be allocated.

Every day we look at the trolley counts and the numbers of people waiting in accident and emergency departments throughout the country.

We also look at the fact HIQA has brought forward reports which leave a lot to be desired in terms of patient safety in emergency departments throughout the country, the impact that is having on the provision of safe care and also the stress and pressure that INMO members are working under.

When I hear talk of comparatives, I am always a little confused because, in comparison to other countries, on one matrix, we have very good representation in terms of the nurse-to-patient ratio but, on another matrix, we have a very poor representation. Are we always identifying the same number of allied health professionals and nurses so we are comparing like with like? Could the witnesses suggest a country where we would be exactly comparing like with like in order to see how we perform in terms of the ratio of nurses to patients? Any assessment would show that the more nurses there are, the better the patient outcomes, as has been acknowledged in the detailed research on this issue.

On another area highlighted by Mr. Doran, when professionals say they have concerns about patient safety, they should be listened to. This is an area where I find that, very often, we do not listen. Consultants have said they are concerned about patient safety due to pressures in hospitals, including communicable diseases, overcrowding and many other associated problems. INMO members have known for quite some time that there is a major concern. Why is there not a more vocal outpouring from INMO members? I do not mean from Mr. Doran personally, because he is fairly good at that, in a positive way. However, is there some fear of reporting among INMO members? That is what I am trying to get at. INMO members are front-line staff on the wards of our hospitals throughout the country and they see issues they are concerned about. There is a reporting mechanism in place whereby they would fill out a form and relay that to management. Is there a fear or a concern that, if they do report, it could damage them in a professional capacity? Is there loose intimidation or a threat hanging over them that would explain why they are not coming forward in the numbers they should be, in view of what we know is happening in our health services? I would be interested to hear Mr. Doran's observations on that issue.

The Haddington Road agreement, industrial relations and what flows from that are for another ministry, the Department of Public Expenditure and Reform. However, the Department of Health also has a key role to play in this area and it cannot completely absolve itself from industrial relations. If the Department of Health does not provide enough funding through the Vote, it then falls to INMO members to make extra sacrifices to ensure the health services can continue. While many of us suggest more resources are needed, there seems to be an obsession with the Department of Health carrying an excessive cut that is over and above what would be deemed normal, even in extraordinary times, particularly given that an extraordinary figure of €4 billion has been taken out since 2007.

Has the INMO a view on the number of front-line staff versus administration and management? We cannot always just throw staff at a problem and there has to be a time when we prioritise the use of staff. When one considers the ratios in the HSE, there seems to be a lot of administration and management, yet the cuts seem to be falling on the front line all the time. I find it hard to understand why we consistently pare back the front-line services and staff before we look at the whole administration apparatus. We know it is a legacy issue from the amalgamation of the health boards and all of that, although my memory of the creation of the HSE was that the first question on everybody's lips, from all sides, was whether the Minister could assure people there would be no job losses. This is an area of concern. I would be grateful if Mr. Doran could address those issues.