Dr. Stephen Kinsella:

All these questions came up time and again. This is called strategic health workforce planning. The strategic element is based on the notion that the policy-makers set a direction for the health system, that it moves to a primary care-based model with large hospitals and subsidiary hospitals. This has been the model we have been saying for many years that we are moving to. If that is the case, then hiring more people into hospitals is not in accordance with that strategy. The model of care is determined in an interplay between what the clinicians say they need and what the policy-makers know from their constituents and from what the experts are telling them is best placed. That is very important as well. The model of care comes from a dialogue between here and the people who run the service on the ground.

Where services are delivered is crucial. For example, if there is an area of the country that is poorly served by an individual service, workforce planning can spot that quickly. It is an efficient way of doing that, because there is a forum for saying, for example, that patients may have to drive for two and a half hours to get treatment. We can then ask whether there is a way to put a system in a satellite spot to help these patients. This is why I was talking about patient flow data, which is vital. One has to know, for example, what proportion of the people of Sligo are visiting Dublin on a weekly basis, and so forth. There is some data on that but it is quite old. I think it was done mostly for cancer care services.

The question of where services are delivered goes back to the primary care model versus the tertiary care model. This model is set at the strategic level and is then backfilled by the quantitative model. To take into account the skill-mix requires a very large amount of data. One has to have each individual service tell one what it needs. Running a cardiac care unit is very different to running an opthalmic surgery. What the service-provider needs is different and they need to surface this, somehow, to the service-provider. That is quite difficult unless we have these data-gathering fora. In Scotland, for example, we found there were very good templates. They were very simple, one-page templates, asking service-providers where they are located, where they think they will be in two years, what they need to run their service at maximum efficiency, how many people they saw last year, and how many people they think they will see this year. In Scotland, they map these simple team composition structures onto the map of clinical care they know they need.

We all have a clinical care pathway we think is the best, but if we did a workforce plan for each clinical care pathway and each one took three years, it would take 90 years to do the whole thing. My suggestion would be to start in a simpler way, then work up to a skill mix. Even in Australia, where they have the most advanced methods, where they know what people are doing by the hour, they find it difficult to do this. My suggestion would be to start with a service delivery model and then maybe incorporate skill mix later on.