Mr. Edward Mathews:

I can inform Deputy O'Reilly that there has been a degree of progress made in dealing with the skills mix. Our submission has clearly recognised that the proper delivery of care within the health service must be evidence-based and significant work on that has occurred. For instance, there has been very significant work done on the acute medical and surgical area. The task force on staffing has clearly identified that one needs a proper skills mix that looks at the roles played by nurses and midwives, whether they be advanced practice nurses and midwives, specialists or more pertinently, in this context, the staff nurse or midwife and the role of the health care assistant. That work has been done. There is some willingness, it would appear, to move that forward but there is not a sufficient willingness to implement an appropriate evidence-based skills mix. The delivery of care must be evidence-based. It must be based on an acuity and dependancy assessment that looks at the type of patients being cared for, and the appropriate professionals and other health service staff that should be available. They should all be appropriately trained including, as we have said in our submission, the minimum training for a health care assistant within the system and obviously then the regulated profession of the staff nurse and midwife grades.

The Deputy asked whether the blockages could be addressed. There is no willingness to understand and accept, within the system, that reductions in the levels of professionals and the appropriate personnel available to treat patients is causing difficulties such as increased waiting lists and increased emergency department trolley figures. Very importantly, the registered nurse forecasting study, RN4CAST, shows that mortality rates increase when one does not have the right skills mix within a particular work location. I have focused on the medical and surgical inpatient areas. We must also consider the maternity strategy and the requirement for the appropriate number of midwives to birth with a nod to Deputy Madigan's points on the role of midwives, to which we will come back.

The requirement is for an evidence base. Nobody can spend money on the call of a particular person or profession for anything. The evidence base has to be the acuity, dependency or birthrate or both, depending on the area one works in, who are the appropriate professionals to meet that and whether the system then will accept that those staffing levels and staffing mix must be based on patient need and not based on the current budget allocation. We do not have to look too far away to the terrible realities, multiple deaths and significant systemic difficulties that arose in the neighbouring jurisdiction where budgets became the primary driver of what care would be delivered and not the quality of care required. We must move away from that system and towards a system that recognises the minimum level of professionals and other staff that are necessary.