Mr. Tony O'Brien:

Before I respond to the questions, my eagle-eared colleague has told me that I may have said that emergency department admissions are up by 8% instead of 1.8%. If I did, I apologise.

I will respond to the questions in the order they were asked. On the real experience that Deputy Kelleher has reflected to us, we have to accept the reality of that. None of us would pretend that at a time when excess numbers of people are waiting for very long periods on trolleys, that experience is anything other than a negative one. There is no question of that. However, I take issue with the suggestion that hospitals may be seeking to hold on to patients in order to manage their budgets in some way. There is no way that statement can be supported or accepted. If hospitals were doing that, it would be difficult to understand how they managed to spend €268 million more than their budgets last year. They are keen to ensure that patients are placed in the appropriate setting because the reality is that if a person is well, a hospital is not a good place for him or her to be. The people who work in hospitals know this more than anybody else.

On the trolley-INMO numbers in regard to trolley usage, the agreed definition used by the special delivery unit and the INMO is that these should include patients who are waiting for a bed. It is only in the those circumstances that they are counted. If a person is in the emergency department for assessment or treatment which is going to conclude within the emergency department or triage area, they do not show up in those numbers. That is the reason these numbers are so significant. While there may be odd minor variations between the hospital trolley use count and that of the INMO, it is an issue we do not get into an argument about. We accept there can be small variations. The overall headline figure is roughly the same.

The key difference is that in April 2013, the INMO decided to introduce an additional measure. On the website this is clearly identified as an additional and separate measure. It is called Ward Watch as distinct from Trolley Watch. This means we are comparing trolley numbers now with trolley numbers in the past rather than ward numbers. However, the INMO wishes to highlight both, for reasons which it has articulated clearly. There may be variances in that. It is an issue of bed use generally for other purposes as opposed to people in additional beds in wards. This would, for example, include the use of beds dedicated under normal circumstances for day surgery or in elective wards. These beds would tend to be counted in the Ward Watch figures. We keep a clear distinction because for a patient on one of those wards as opposed to on hold in the emergency department, there is a very significant difference in both the quality of the experience and almost certainly in the quality of care. The HSE and INMO are agreed that both should be reflected separately, although that distinction tends not to seep its way through to the public discourse.

On the recruitment issue, there are as we speak discussions going on with some of the key stakeholders in this regard. We are clear that the marketplace we need to target is the return of Irish-qualified nurses from the United Kingdom. Britain has been very effective at tempting our qualified nurses away. We are in discussions with the INMO and others about how we might best package a recruitment process to seek their return. We do have one disadvantage in that our salary scales start more or less in the same place. While I am not sure about this I think our salary scale increases by five or six points while the UK scale increases progressively to about 12 or 13 points. We clearly need to ensure that there are opportunities for those who do return to progress in their careers. This is exactly what we are looking at with the INMO. It is hoped this will result very quickly in an active recruitment campaign of Irish nurses in Britain, many of whom I believe would prefer to come back to Ireland, particularly if they have not sown long-term roots, as many will not have done yet. As part of our recovery, this is an area we need to tap into. We will be seeking to recruit directly for particular hospitals because people will want to return to the areas from which they came and so on. Local recruitment within that vehicle will be part of the exercise.

In regard to my earlier use of the word "managed", members may be attaching a little too much significance to it. I used it in the following sense. The Minister managed to secure a budget for the health service this year of €635 million more than it was last year. In doing so, he exceeded my expectations. He managed the process in that sense. There is no negative connotation in that regard.