Mr. Tony O'Brien:

Mr. Woods will address issues relating to Our Lady of Lourdes hospital and Mr. Hennessy will address the palliative care and cost of drugs issues.

On the 200 beds referred to by Deputy Fitzpatrick, these are opening on a phased basis. Some of them are already open and others will open within a week or two, all based on recruitment profiles. There will be 16 beds opened at the Clontarf unit; 25 at Cuan Ros; 25 at St. Vincent's, Fairview; 25 at Ballinasloe; ten at Farranlea Road, Cork; four at Heather House community nursing unit; five at the Ballina District Hospital; six at Sacred Heart, Castlebar; two at Ard Evan, Carndonagh, eight at Killybegs; five at Merlin Park Hospital, Galway; five at Áras Mhic Dara; 12 at the Hospital of the Assumption; five at St. Ita's, Newcastle west; and 20 at the Royal Hospital, Donnybrook. I should emphasise that these beds are provided as responsive measures and are not permanent openings.

On the issue of senior decision-makers, there is no real relationship between senior decision-makers and delayed discharges. At the point at which a person is classified as having a delayed discharged, he or she has already completed an acute phase of care and a decision-maker has signed off that he or she is fit to be discharged. The issue of senior decision-makers is more a front of house one. In certain locations where it has proven more difficult to recruit senior consultants and there is an excessive reliance either on temporary consultants or on more junior staff because of the absence of senior decision-makers, this tends to result in a higher than typical admissions profile from emergency department presentations. This means that patients who might otherwise have been discharged by a senior decision-maker are listed for admission, which adds to the number of people awaiting admission and, therefore, increases the number of people on trolleys. The senior decision-maker issue is key in terms of trolley counts but only in a small number of locations where there are typical or patterns of difficulty in recruiting staff. This is often the case in some of the smaller hospitals on the western seaboard.

On Senator Burke's questions regarding vacancies, the vacancy profile is likely to have been changed significantly by the announcement by the Minister for Public Expenditure and Reform of a further extension to next year of the grace period for retirements. There are likely to be consultants and senior nurses who but for that announcement, because it is persons above a certain income threshold who stand to benefit, will not now, we hope, be retiring but will continue their working careers. The Senator is correct that we need to ensure that we accelerate the pace at which we recruit known future vacancies. However, in that regard we must take into account the fact that an individual is not obliged to give us significant notice of their intention to retire. In other words, until an employee has actually formally indicated his or her retirement, we would not be at liberty to proceed to recruit to replace him or her. I am certain there are ways we can improve the position.

On the issue of appointments without interview, it is important to stress that these are not persons coming in off the street into jobs. Rather, they are people who had previously been through a recruitment process and were already employees of the relevant health entity, be that the HSE or one of the agencies. The process of moving people from one role to another was a by-product of the employment moratorium at a time when certain grades of staff could not be recruited while at the same time more senior personnel were being encouraged-persuaded to leave the system via incentivised exit processes. This is one of the reasons there are so many people accounted for in this way, in addition to the regularisation process, which was broadly speaking provided for under the terms of the Haddington Road agreement. During the same period, one of the hardest cuts to the training budget in the health service was imposed. It is something that during my time in the HSE we have sought to reverse significantly. It is undoubtedly a by-product of that period that some people were promoted more rapidly than might otherwise have been the case because more senior staff were exited from the system and that they could not be supported in the way that one would wish when people are promoted. There are now significant programmes of development in place through HSE learning and development, funded external training programmes, funded third level training, action research and so on.

An internal audit is under way. We have been in correspondence with the Committee of Public Accounts in relation to that audit and in relation to the consistency of the application of the regularisation protocol to ensure it was done strictly in accordance with the terms of the relevant circular. This process is, as I said, currently under way by the HSE internal audit function.

In regard to Our Lady of Lourdes Hospital, I will pass over to Mr. Woods to comment on that. Mr. Hennessy will then comment on the drugs issue and I would like to come back in again after that.