Mick Barry (Cork North Central, Anti-Austerity Alliance) | Oireachtas source

I thank Dr. Kinsella for the talk and for the many interesting things to ponder. I have three questions. They relate to the issues of demographics, the question of current staffing levels and the increasing use of agency staff within the health service and hospitals in particular.

It would seem to me that one of the tasks posed here is to look at the big picture and the broad brush stroke before getting down to the detail. I am calling on Dr. Kinsella to comment. It would also seem to me - again, I am inviting comment on this - that there are two issues which point in the direction of significantly increased staffing levels in the context of putting forward a plan. The first is the issue of demographics. The map on the dependency ratio with the M2 F2 graph is quite dramatic. Dr. Kinsella referred to an increase of 12% to 15% over a period of ten years or so. One statistic relates to the numbers of our population over the age of 65 years. Currently, the figure is below 600,000 and about 585,000. That is set to rise within ten years to 850,000 or perhaps beyond to 860,000 or 870,000. There will likely be an increase of approximately 50% in that one group within society. There is another statistic on the prevalence of chronic disease. It is not entirely linked to the demographics, but it is not unrelated either. The figure is expected to rise by 4% or 5% per annum. That figure was produced by the Irish Nurses and Midwives Organisation. It strikes me as a very strong statistic.

I am also wondering how we factor in other things. For example, there are things that people may not be presenting for now but for which they will be presenting in five or ten years' time. Let us consider mental health and the question of depression. The culture is changing and it is becoming less of a stigma for a person to say that he is feeling bad and needs help, but there remain many people in society who would not present with depression or anxiety. They would rather try to power through and batter on. There is a better and more open attitude among the younger generation. I imagine that as the demographics shift, there may be an increase in mental health issues. I suspect there will be, but there may also be an increase in the number of people willing to present and say as much.

Considering those factors together, it strikes me, particularly on the issue of demographics, that it points to an increased need for health services and recruitment of professionals within the service.

The second issue is current staffing levels. The graph is interesting. It shows worker numbers in the health service to be down perhaps by about 7% on where they were in 2008. The graph is a somewhat optimistic one because it points upwards. However, I think it would show a plateau if it included the numbers for 2016, because there is this X and Y policy now, as enunciated by Tony O'Brien of the HSE, that one can only hire Y if X leaves. Therefore, while there was an increase in staffing numbers of more than 4,500 the year before last, I think last year there was a plateauing of the situation. For example, we are down more than 3,000 nurses on the 2009 figures, and there are quality of care issues such as the linking of bed closures to staff shortages and so on. Again, I am inviting comment, but to me these issues point also to the need for significant recruitment.

My final question concerns the issue of agency staff. Anecdotally, I am getting back from health service workers reports of a very significant increase in the number of staff being brought in from agencies. This applies perhaps particularly to nursing. I saw one figure which indicated that there is a budget this year of €226 million for agency staff and that half of the budget had been exhausted by the end of April. In other words, a third of the way into the year, half of the budget had been used. It also strikes me that if one is planning in a sound way, surely there is a very strong argument to base staffing fundamentally on the recruitment of full-time permanent posts rather than using agency staff, which seems to me the epitome of short-termism. One is considering not just quantity, but quality as well. Obviously, if someone is employed in a hospital, he or she works there and it is good for morale - there is an issue with demoralisation in the health service - and it will improve the quality of the work. Would Dr. Kinsella therefore agree that an over-reliance on agency staff is an indication of short-termism and that a more planned approach would base itself far more on the recruitment of permanent staff?