Mr. Liam Woods:

The points made in relation to recruitment and retention are well made. While pay levels are an issue they are far from the only issue. Working conditions and training opportunities can be incentives or disincentives in terms of people's likelihood to remain in-post. The location of training posts is also an issue. When we move away from large areas there are relatively few training posts and that is a big factor in where our junior doctors choose to work. We have seen evidence of this. We have also seen some good progress in that area. I was recently in Letterkenny hospital where a great deal of progress in terms of training has been made. The staff being trained have very much enjoyed their time there. There has been very strong focus from the consultants in Letterkenny General Hospital.

In terms of nursing, there have been some very astute interventions with graduates in recent times to offer them contracts in our environment. There is, of course, strong international competition in this area, of which members will be aware. The private market has been a significant incentive in terms of sign-on to particular grades, including nursing. We have had some success in this area recently, which we need to build on. My own dialogue with nursing organisations would indicate strongly that training is a key driver. In terms of where we go, it is right to say that while we still spend significantly on training, most of that is now what is required by regulation and law rather than additional training. That is a point of focus.

The other point that is relevant is that the creation of groups affords opportunities to deploy clinical staff across multiple care environments. This gives staff opportunities to work in different types of environment and conditions, which would not have been possible in stand-alone units be they large or small. That is an opportunity that has to be grasped by the groups. It is a way of securing the role of all units. It is already visible through some of the interaction of the groups that this is going to bring benefit, and has to some extent already.

On the point of the on the Estimates, we have already approved the posts mentioned into our Estimates. I understand the Deputy's point around them coming back out of the Estimates. His point is well made and I get it. The points on the availability of staff and our capacity to continue to provide safe services and to expand that capacity as we face increasing demographic pressure, which we do, are also points well made. The underlying point about recruiting and retaining staff is probably, in my own experience of interacting with the acute environment, one of our top priorities. We have to find ways to do that. Members will be aware that we are engaged internationally to support staff recruitment. We need to do the same on an ongoing basis locally. I will ask Dr. O'Reilly to now make a brief comment from a group perspective.