Colm Burke (Fine Gael) | Oireachtas source

My apologies for being late. Unfortunately, I had a prior engagement which was arranged more than two months ago and I could not get out of it. I apologise for missing Mr. Doran's presentation. Following on from his replies to earlier questions, on the management structure in the HSE, we have seen it happen in the private sector during the past two to three years where, for example, one organisation reduced its seven grade management structure to three. Does Mr. Doran consider it is time to examine this in the HSE and are there certain grades that are not needed? One of the concerns I have about the management structure - I spoke to the Minister and the Taoiseach about this recently - is that many jobs are now being filled on a temporary basis. Staff are in temporary positions for two to three years and then suddenly find they are permanent. Once there is a vacancy, they are moving up the line without going through an interview process. That is the information I have received and it is an issue about which I am extremely concerned. My first question is does Mr. Doran believe we need to consider reducing the number of layers in the management structure?

The second issue I wish to raise is the cost of agency staff. I have consistently raised this issue during the past three years, particularly when it was focused on junior doctors, and we have now moved on to consultants and nursing staff. We have an overall figure, but does Mr. Doran have a breakdown of the cost of agency nursing staff? I may be incorrect, but I understand agency staff costs in January alone were €10 million. Does Mr. Doran have an idea of what the total cost of agency staff will be in 2014?

The third issue I wish to raise is that of maternity hospitals. It is one about which I am very concerned, as are the delegates. I understand nursing staff in Portlaoise hospital had been filing their concerns consistently, not for a number of months but for a number of years, and no action has been taken. I have compared the position in Portlaoise hospital to that in a school. A toal of 1,000 babies a year were being delivered in Portlaoise hospital and that number increased to 2,000, but the hospital had fewer rather than more staff to deal with the increase. If we compare this to the position in a school in which the enrolment has increased from 1,000 to 2,000 pupils, all hell would break lose if it were to be left with the same number of teachers to deal with the increased number of pupils, but we seem to have accepted this position in the case of hospitals, especially maternity care services. We have a further report this morning on Cavan hospital on access to a theatre. We have a number of problems in maternity hospitals, especially the 11 smaller units around the country as regards the provision of adequate support, especially nursing staff.

To return to Portlaoise hospital, why was someone not forced to take action once nursing staff had filed genuine complaints and concerns? Where does the buck stop? Who did not take action when it was clearly indicated that it was urgently required? I understand a large number of genuine complaints were filed by nursing staff in the hospital and also in other units where no action has been taken. Where does the buck stop? If it is not with the hospital manager, where along the line does it stop? What is Mr. Doran's organisation trying to do and how can we assist him to make sure we will not have a repeat?