Colm Burke (Fine Gael) | Oireachtas source

I thank the witnesses for their presentations and for their work. In the past three years, since January 2015, we have taken on more than 11,000 additional staff in the HSE. I understand that the numbers have gone from 99,000 to more than 110,000. However, that increase in staffing levels does not seem to have delivered any additional capacity. What are the witnesses' views? Was there a plan within the HSE as regards prioritising where people should be employed? Is it prioritising the areas that can deliver a better service?

I wish to ask the IMO representatives about the contract negotiations. We are talking about a contract that is more than 40 years old. Agreeing a new contract will take time. Could any element of the negotiations be expedited or fast-tracked to support GPs to deliver the service they want? If we can assist them, they can provide a better service which, in turn, will take the strain off other services within the health system.

Returning to the INMO presentation, Ms Ní Sheaghdha referred to the reconfiguration of the health service. What aspect of reconfiguration are they talking about? If that proposal has been given to the HSE, is it the case that the HSE is not responding or does not want to listen to outside bodies? For instance, I did a report back in 2012 on university graduates and final year medical students. More than 60% of those graduating that year confirmed that they intended to leave the country within 12 months.

That was six years ago and we seem to have done very little to encourage people to stay. From the IHCA and IMO point of view, there seems to be a significant drain on doctors across all categories, including existing consultants who have been in situ for some time. Apart from the pay issue, there seems to be a serious morale issue in hospitals. Is this because of the structure of management? I was recently contacted by a consultant who had to take a decision on the management of a patient on a Sunday night. Three administration people were more or less telling the consultant how to manage the patient. I become concerned when I hear this is happening. Is there a problem with the managerial structure in the HSE and insufficient effort being made in training managers? Nursing staff, medical staff and care assistants go through a whole spectrum of training. Is the HSE providing enough training for managers to achieve the best possible outcomes in delivering services in the health system and ensure people work as a team rather than working against one another, which seems to be one of the problems?

With regard to pay comparisons, all the organisations referred to pay, which is only one reason for the difficulties we have in the health service. It would be useful to have comparisons showing the pay of nursing staff, staff nurses, junior doctors and consultants in other countries. It is important to have such comparisons. Very good presentations were made here this morning, many of which touched on pay but we have not seen comparisons with other countries. It would be useful to see what we are competing with.

The other issue is the ratio of doctors to nurses in the hospital system. I have not seen any comparisons of that ratio with other countries. A number of years ago, I had to attend a hospital outside Ireland for medical treatment that was not available here. It struck me was that the ratio of nursing staff and doctors was much lower than in Ireland, whereas there were far more care assistants. Have we done comparisons with other countries? I am not saying we should reduce the number of nursing staff or doctors but we could get a better delivery of service using other people in other areas. Can we have some comparisons on that issue?