Mr. Eamonn Donnelly:

I will be brief. The questions are linked to a chain of answers. I will add a point on one of the questions Deputy Kelleher raised earlier and with regard to what Mr. Liam Doran said about nurse and patient ratios. We agree with all of that but there is a populist view that our health service is bloated with managers, administrators and the like. I have the census with me. If we are discussing staffing levels we should not take the easy default position that it is bloated with managers. Managers currently account for 1.33% of the entire staff. That is in line with the NHS model, according to the Minister's research. The total percentage of administrators, right down to the people who compile charts for doctors and consultants, is approximately 15%. If we are going to get into a debate about beefing up staff numbers, I wish to make it clear that it is not just a question of us having too many managers and administrators.

However, that leads to a chain of thought about managers. Deputy Kelly mentioned the nine CHO areas and the seven hospital groups, which does not make sense to many of us. These managers must manage this. One talks about restructuring fatigue. That is at the heart of it because they are being asked to manage something that, quite frankly, many people do not believe in. They must try to introduce these things on a daily operational basis when there is a complete lack of buy-in from people because they do not know what is coming next. That leads to Deputy Harty's question about demarcations. Demarcations are probably imposed by the system. The cross-referral mentioned by Liam Doran is exactly what I am discussing. Whether it is in nine CHOs, five community areas or whatever, if we could move to community care where there is cross-referral between highly-qualified professionals, such as occupational therapists, physiotherapists or public health nurses, that would remove much of the demarcation. Our people are up for that challenge. The difficulty is the lack of a vision presented to them and the lack of ability to manage that, because nobody is clear about what the vision is. It is causing a slow-down in the system.