Maire Devine (Sinn Fein) | Oireachtas source

I thank the witnesses for their patience and for the comprehensive presentations and appendices provided. I come back briefly to the emergency overcrowding protocol. We are taking risks when we look at who to put on leave, who to give extended leave and, in particular, who to discharge. I acknowledge that it is an emergency protocol, but it is risky for clinical staff.

I am known for my brevity and will not go on too long. The moratorium was damaging to staff but the insulting graduate nurse contract offered several years ago has created a damaging legacy in the context of trying to recruit staff. Issues with the recruitment of nursing staff in the east seem to be much more prevalent than elsewhere nationally, which is saying something. It is a problem for every CHO area, but in particular for the east. What contracts are being offered to staff? What is in them? Are they flexible? We spoke about agency staff and their cost. Some agency staff do not necessarily wish to become full-time employees or to sign a contract. Are we flexible enough? At one stage we were saying that if someone could offer four or more hours, that person should contact us. I do not know if it is less than that now. What flexibility, educational opportunities and opportunities for advancement are there, in particular in nursing where one has CNSs and ANPs and where we could run a nurse-led health service at a much reduced cost?

Of the budget, perhaps 80% goes to payroll with 20% going to different services and infrastructure. What is the breakdown between front-line clinical staff and the back-up support staff who are so important but who are providing administration services? I tie that in because I want to know if we have plans, and if so, how advanced they are in the context of the paucity of IT and its use, which has been startling to the committee. IT is a low priority but if we train enough people, we will need fewer in the long term. We would have a lot more continuity and care would be easier to access, as would records. The gap in whole-time equivalents in CHO 6 is verging on 50% in some instances. I do not know if I am reading the statistics right and stand to be corrected.

Linn Dara has been a bugbear of mine as the Chairman will know. It is open. How many beds are operational there? I have harassed two Ministers at least over the last several months and eventually the facility has opened. What are the waiting lists like, including Fairview and the CHO 6 area?

Is the budget based on population or the historical location of asylums? Has that changed and has the position been modernised to refer to what is needed according to the population? What is the budget for section 39 bodies, including Jigsaw and those which offer services on the ground, including CAMHS in particular? Are there contingency plans for the proposed strikes on Valentine's Day? What is the breakdown of the budget for section 39 services? The spirit of A Vision for Change must include value for money. What do the section 39 services provide in that context and how much value do we have in terms of outcomes? Can we measure outcomes or do we just allow the services off to provide what they believe they need?