I thank all the witnesses for their presentations today and for all the work they have done over many years on behalf of the voluntary organisations. Both reports are very welcome. I will start with the increase in the health budget over the last four years. There has been a substantial increase. Have comparable amounts of money been allocated to the HSE and the voluntary sector? We are talking about €3.3 billion. I think that is nearly the same amount as four years ago. Has the comparable increase been looked at? My second point concerns staffing levels in the HSE. There has been an increase of 13,000 in four years and 2,700 of those are in administration and management. I have serious issues with that. Staffing in public health nursing has only increased by 3.7% whereas there has been an increase of 17% in administration and management staff in the HSE.

I do not believe there has been a comparable increase in staffing levels in the voluntary sector. If anything, there has probably been a greater demand on the voluntary sector to do the same amount of work with fewer staff or do more work with fewer staff. Has a comparison been done between the increases that have occurred in the public and voluntary sectors?

There is a lack of understanding in Ireland about the contribution of the voluntary sector and the organisations working in it. I remember approximately five years ago going through the HSE's annual report and seeing more than 2,500 organisations getting funding and trying to explain it to the general public. Does the voluntary sector need to get more information out there about the services it delivers and how cost-effective it actually is? I know the nursing home sector is not comparable because it is very much the private sector and not the voluntary sector but I have seen that a relatively new nursing home run by the HSE costs €1,600 per bed per week whereas a comparable facility three miles away receives €900 per bed per week to look after the same demand for patients. It is the same with regard to costings for the voluntary sector. It appears to deliver very effective care to a large number of people at a very efficient cost but does not receive recognition for it.

Will the witnesses comment on increasing demands? In private session this morning, I raised one aspect of the HSE whereby the staff of an entire section resigned because they cannot cope with increasing pressure from the general public requiring the service to be delivered. To put my cards on the table, this is because of a lot of adverse commentary in the media. For instance, if a voluntary organisation runs into any difficulty, the media immediately seem to focus on that particular aspect of the organisation without looking at the overall picture of what the organisation does. Voluntary organisations are, unfairly, very prone to adverse media coverage.

The report shows the need for us all to work together, including the general public, voluntary organisations, the HSE and the Department. There is a disconnect and the question now is how do we go forward. It is not only about the HSE and the voluntary sector working together but also the general public. There is only so much a voluntary organisation or healthcare system can do. Perfection cannot be provided in every area but we have reached a stage where people are looking for perfection that we cannot deliver. How do we get out the message that everyone has a part to play, not only those providing the service and working there but also the general public? I might come back to make a few more comments later.