Dr. Stephen Kinsella:

I do not know but I can check and get back to the Deputy.

There is an IT workforce deficit but there is a very large spend in the Department of Health on IT. In respect of the eHealth strategy and data analytics, there is a deputy secretary just for data analytics and research who is a very good and competent person. My hope is that one can ally this with those data gathering initiatives. What is the capacity if we turned it on? There are people who have produced workforce planning models in SOLAS.

Professor Eilis McGovern and her team in the HSE have done considerable work as well. A group in the Department of Health has done this work to a high standard for midwives and nurses. In terms of boots on the ground, the capacity to deliver the service exists, at least in skeleton form. We would need to buttress it by adding in more people. Another group that would be very useful is the Irish Government Economic and Evaluation Service, IGEES. Some of our best University of Limerick graduates are with that group now. These are really smart people and very numerate but, most important, they give us a direct connection back to the Department of Public Expenditure and Reform because that is where they were originally located.

Deputy Kelleher asked several questions, including one on the private versus public health system. This is the main reason I do not recommend either the Scottish or Welsh models. It is also why the governance structure should be managed between the Department of Health and the HSE. The Department can compel access to some of the data from the private systems whereas the HSE cannot.

Data issues abound. Assessing performance has to be done on qualitative and quantitative basis. If we set a target, then people will move to fulfil the target. If we do not have the qualitative elements along with other data, then all we get is people trying to hit targets. Some of the best performance models set the targets but do not tell anyone what they are. It is really interesting. They set they target and then tell those involved simply to try to do the best they can. They found that everyone exceeded the target. Behavioural economics suggests that if we give people a target, they work to it. There is a great example involving Boston firefighters. They brought in a rule to the effect that no one could be absent for more than 15 days per year. Then, the absenteeism rate exploded because people realised they could take 15 extra days. Staff who had not taken a day off in 20 years then took 15 sick days. Then, when they removed the cap the figure stayed at 15 days. We should be careful of the targets we set.

Can we assess efficiencies in workforce planning? We can, but it is typically done through the price system. People try to figure out how expensive it is to recruit 100 new consultants or 25 new phlebotomists and so forth. Typically, it is done through the price system. The Australians have a very good system but I would caution against introducing a similar system immediately. It comes back to work practices. If we were to ask every consultant and nurse what they do on an hourly basis, I do not think they would be able to give an answer. Producing the system to give us that answer would be enormously destructive in terms of the trust we want to build up with everyone. I would do that only as a last step, if at all.

Forecasting quality is absolutely vital. It turns out that we can figure out whether forecasts were of high quality. We relate the forecasted levels to the levels that actually materialised. Let us suppose we have six different anaesthetist groups and we are forecasting their levels. Then let us suppose three are bang on. We can measure that by the amount of latent demand. If we have three people with a fairly average waiting list and then two others over-claim and have no waiting list while three other people are waiting around not doing much or doing mostly private work instead, then we may have overshot here and undershot there. It is a rough balancing act over time and we can see that, especially with the qualitative element.

Is there a tension between these developments? There is, absolutely. There is a question of leaving it with the Department of Health and the HSE and then perhaps putting it with a body like the ESRI. There is a tension. In Australia they created an entirely new institute of workforce planning and had what was almost an ESRI body for workforce planning. Then after some years they ended up nationalising the organisation and bringing it in to the health service again. There are many different models to make it work. I am uncertain whether such a body should be independent of policy. I think we would want it to be fairly connected to the policy-making system. Otherwise, it ends up evolving into a fairly technocratic dry exercise where someone produces numerous charts and people say it is grand but there is no action. It needs to be close to the systems of power, including the committee.