Ms Mary Day:

With regard to bed capacity, very low numbers of beds, only 30 to 40, are closed in my group due to staffing. As for whether it is due to physical or staffing causes, I would argue that when we look at bed capacity it is about having the right bed in the right place for the appropriate patient. We have done a lot of work in recent years on reducing the length of stay in acute hospitals. We need to look at having sufficient rehabilitation, reablement, step-down and transition beds. We need to see patients being taken from the acute system into appropriate beds. This is not just looking at how we develop our bed capacity but also our processes. In 2016 no patient should be signing a fair deal application form in an acute bed. Going into a nursing home is one of the most important decisions an elderly patient will make in his or her lifetime. With regard to looking at bed capacity modelling, we need to examine length of stay, processes, having the right beds in the right place for the appropriate patient and pathways to deliver this.

The recruitment issue also involves retention and workforce planning. One of the first things we need to do is look at workforce analysis throughout the group and whether it has the right number of people to meet the service delivery. In Wexford we have begun work on a very thorough workforce analysis in the hospital, which will be rolled out to our level 3 hospitals and then into levels 2 and 4 hospitals. Over the years we have not been that good on having the right numbers to deliver the services. From a nursing home point of view, the Department of Health is doing very thorough research on having the right skill mix. Retention is very important, and this is where the groups can deliver good strong initiatives. In the Ireland east hospital group the universities play a big part in training and education. In the Mater hospital and St. Vincent's University Hospital we want to deliver two academic hubs, which will link in with level 3 hospitals and deliver education and training to staff delivering care at the bed side.

As is the case with Dr. O'Reilly's hospital group, ours has a mix of statutory and voluntary hospitals. It would be helpful if we had a single recruitment entity in the group as we could recruit for the group. This should be part and parcel of future legislation. At present, statutory hospitals recruit under the HSE arm. We have six voluntary hospitals with their own boards which recruit. Of course as a group we have an employment control framework, but a single recruitment entity would give us flexibility. We are looking at developing a nursing bank throughout the group. If we had this, a nurse living in Wexford working in St. Vincent's University Hospital could take a shift in Wexford on his or her day off. This is the type of flexibility we would look at. It is all about having a single employment authority.