Mr. Peter Hughes:

If a director of nursing left the service and the person who got the position was an assistant director of nursing who happened to work in the same service, that assistant director of nursing will have to be replaced, so all the steps will have to be gone through again but that cannot be done until the assistant director of nursing moves into the director's role. If the person who gets the assistant director of nursing role happens to be a clinical nurse manager from the service, he or she will go in as the assistant director of nursing and we will then have a vacant clinical nurse manager position. For example, in the geographical area of Donegal most of the people on the panel will live quite near the area, perhaps in Sligo or Donegal, and they may already be part of the Donegal or Sligo service. It may go down as far as replacing the staff nurse. Technically, all of the positions have to be filled. This will have to go to the monthly pay-bill meeting, where a majority will have to agree the risk assessment means the nurse is needed. Why would an area with a significant number of vacancies need to go through a risk assessment at a pay bill meeting to fill a particular post? It is very obvious the post must be filled if there is a significant number of agency nurses and amount of overtime in the service. Why must it go through that process? It is a layer of bureaucracy that is not required.