Mr. Tony O'Brien:

Dr. Pat Nash is the commissioner of the review. He will do that in consultation with the families.

There was a two-part question on consultants, one part from Deputy Ó Caoláin and the other part from Deputy Kelleher. The conclusion of the recent talks, and the substantial reversal of the additional pay cut that consultants were subjected to in 2012, is a key contributor to our ability to resume the effective recruitment of consultants.

Deputy Ó Caoláin referred to vacancies. There will always be a certain number of vacancies due to churn, which I think is understood, but that number is abnormally high at present. However, although there have been several hundred competitions that have closed after selecting candidates, in many cases it was not possible to get them into employment until this recent pay issue had been resolved. A significant number of these posts will now be filled on the basis of competitions that have already been completed. In addition, we are now proceeding to advertise other vacancies. There are 30 posts to be advertised this week, and there will be further waves. My expectation is that while there will always be some level of churn-type vacancies, we are now going to see a significant change in the pattern of vacancies. That will bring us up, over the course of the year, to the position that we would wish to be in.

As the Deputy correctly stated, with population change and increasing demands and so on, there are always cases in which we might wish to create additional posts. That will be dependent upon an assessment of priorities, the availability of resources and then the process of a competition. We are limited by the fact that there is a scarcity of supply of specialists in some disciplines. It is not a universal issue, but this is true of certain disciplines. The situation, I think, will change quite significantly in the next short while, and the recent pay agreement is critical to that.

In regard to the broader issue, the Minister of State, Deputy Lynch, has already referred to her assessment that the Fair Deal scheme should be regarded as a demand-led scheme. In fact, in many ways it is perfectly set up to be a demand-led scheme. The problem with it is that there is lots of demand and insufficient resources, and that is a direct result of demographic change within society. Let us be clear that it is a good and positive thing that more of us are aging and that we are living longer - none of us should ever characterise that as a problem - but it does create a need. That need is best exemplified by the fact that as at 29 November there was a 15-week waiting period, beyond the process of financial assessment, to gain access to a Fair Deal bed, and the number of people in that queue stood at 1,937. Due to the measures that I referred to, by the 5 January that waiting period had been brought down to 11 weeks. That does not sound so dramatic, but the dramatic change was that the number waiting had been reduced by 759 to 1,188. Today, the number stands at about 1,234. That is partly because, as I outlined in my opening statement, we are seeing more people going on the list than coming off, even though we are taking off more people than ever. The funding we have applied will sustain the 11-week waiting period until approximately the end of this month. In the absence of additional resources to be applied to that scheme, our concern is that by the end of the year we will reach a waiting period of between 18 and 20 weeks and see 2,200 people on that list. While I do not wish to be alarmist, in many respects, when we look at what is happening in the acute hospital system right now, it could be said that the funding mechanisms and the arrangements for the Fair Deal scheme, as welcome as they are in terms of the benefit it brings to those who gain access, has become the Achilles heel of the acute hospital system. There is a direct correlation between the increase in waiting time and the increase in numbers on the waiting list for scheme, the numbers of delayed discharges in hospitals and the numbers recorded as waiting for admission on hospital trolleys each day. Unless we solve that problem we are going to be in for a very difficult year in 2015. That is not to say it is not already difficult, but it will be more difficult.

In regard to the question of where I see clinical risk, I see clinical risk arising as a consequence of that. This is the direct result of demographic change. In most Western societies which did not experience the type of economic implosion that we experienced a few years ago, when they talk about health cuts they talk about bending the curve of increase of expenditure on health. In Ireland, as of necessity, we have had to contemplate actual reductions in expenditure on health. We need, as quickly as we can - hopefully, the signs of economic recovery will facilitate this - to get back to a point at which the demographic impact can be reflected in a demographic allocation. We have not been there. I regard the service plan as realistic in that it said there would be enough money to hold services as they were but not necessarily enough to meet increasing demand.

The other consequence is that, when faced with the number of people on trolleys that we have, it is an inevitable and unavoidable consequence that access to hospitals for non-urgent elective procedures becomes curtailed. While something may not be urgent, that does not mean it is not chronic. It does have an immediate adverse impact on the person whose admission is delayed and it can mean that over time the person's condition deteriorates, meaning that he or she needs a greater intervention than he or she otherwise would. That is essentially what was referred to in the bones of the question.