Mr. Liam Woods:

I am aware of the point that the Senator raised about Cork and Kerry and the waiting list issues for gynaecology services.

As part of our overall approach to waiting lists for this year, to which the Minister referred earlier, we are seeking to remove all of the long waiters. There is a focus on bringing those waiting, in both time and number terms, back to 18 months, but also behind that mark as best we can. The challenge, from our point of view, is interesting. Looking at our own data, the slight fall in the number of births, back to approximately 63,000 to 64,000, is leading to an increase in the provision of gynaecology services, but there is also an increase in demand and we are working with that. I have dealt with the south-south west area group on that issue specifically in recent times.

On the Portlaoise report and the recommendations, a detailed list of all the recommendations is reviewed on a monthly basis, both by the HSE and the Department of Health, and it is published on the Department's website. I will make a couple of observations about the points Senator Colm Burke referred to specifically.

On obstetrician numbers, as I understand it, the number the Senator quoted is approximately the number - 130 whole-time equivalent obstetricians. If the Senator requires any further information on that, it is available. We appointed some additional obstetricians during the course of last year because funding was made available for that purpose and we will be able to do so again this year. In terms of numbers, we would be talking about between five and seven obstetricians per year. That is in hand.

On midwife numbers, a specific piece of work was done last year on the number of midwives required for the number of deliveries by unit. That report identified the need for an additional 100 midwives nationally. We have invested in those midwives in the course of this year and last year. Those numbers have been put in place and that analysis will continue. It is a dynamic analysis because the numbers are clearly changing with the volumes of service. That investment has been made.

On the appointment of directors of midwifery by site for the 19 units, four sites had directors of midwifery in place. I do not have the exact number in my head for those advertised and filled, but we still have another four or five to fill based on the first round of competition. The rest are recruited and are being put in place. We are going back to the market. Senator Colm Burke is also well informed in the point he makes about the specification for the role. We have had a look at that. We are working with our colleagues in HR to see how we can express that specification and still maintain a standard, but I understand the Senator's point.

The agency cost generally is over €225 million, over half of which is medical and most of the balance of which is on the nursing side. The HSE has been recruiting with a view to displacing agency staff and it will continue to do that. It is within our current operational remit to do that and it makes sense, as the committee would understand, in every way. There is some amount of agency that is endemic to the system because of the nature of the system, but we are above that amount, which, I understand, is the point the Senator is referring to. We have open flexibility around that recruitment. We are doing that and we have done some of it this year. That represents a financial saving to a hospital and also brings in permanent staff. Therefore, it is very positive. We are doing everything we can both to attract and retain staff in that context.

On the point the Senator raised about the replacement of consultants, in terms of the response I am quite happy to go back and look at a more comprehensive reply and pick up what was referred to in 2014. Perhaps I can deal with the Senator directly on that. In terms of the recruitment process within the HSE generally, there is full capacity to fill replacement posts and there is no obstacle to early approval of posts based on the notion that a replacement is required within a period of time. I understand the Senator's point, which is that it can take time - perhaps up to 12 months - to recruit a consultant and leaving a post vacant or having a locum for that period of time is less desirable than having a planned replacement. I fully get that point. I am aware that some posts are notified in advance and go to recruitment before the posts are vacated. Assuming reasonable notice of the intent to vacate the post, and it is almost always the case that it would be known, there is capacity for that. It is something that would be useful to encourage and pursue further. Operationally, it is within our flexibility to undertake that form of recruitment.