Mr. Liam Doran:

If I may. The fundamental problem is that our health service is too small, too narrow, not integrated and cannot cope with demand - full stop. That has to be acknowledged. It does not matter how we shape it up or talk about process. That is the harsh reality of it. No matter what measure we apply, acute bed, continuing care bed, traditional care bed or community-based services, none of them is sufficiently wide, deep, high or long to meet the demand that is placed upon them. That must be accepted politically if we are to address this problem.

I will run down through the questions. In fairness, my colleague, Dr. Emily O'Conor, has answered some of them on which we would not differ. The programme for Government and the performance management unit was mentioned. The one thing we are not short of with regard to emergency departments and health is management measuring. What we are short of is anyone doing anything about it. We can measure everything with regard to emergency departments now: age profile, length of stay, what colour socks a patient has - you name it, we can measure it. However, it has gotten worse. I will say quite clearly that we would not support more performance management people to oversee managers who oversee front-line staff who are understaffed, overworked and always held accountable when the thing goes wrong. If we are going to empower, we have to empower the front line. We have to address the consultant issue, the nursing numbers and the support staff issue. We do not need more management. We know what the problem is.

With regard to agency staff conversion, the committee should know that the latest figures we received from the HSE just yesterday confirmed, for example, that €80 million was spent on agency employment for nursing staff last year. That is roughly 800 staff per day, every day, for the year. That figure is responding, as we understand it, to approximately 60% or 65% of the calls. That is not the full need of the service. The agencies cannot supply the full need because they do not have enough people on their books to do so. That is-----