Mr. Damian Ginley:

On expenditure, our submission highlighted concerns regarding moneys going to the use of agency contractors, etc. Significant amounts of taxpayers' money are being spent on external consultancy expenditure, for example. Millions of euro are being spent on the provision of services via contractors and there was huge expenditure, of €647 million in 2023, on agency spend. Funds are being made available in the health service but they could be better used in some cases to provide more direct employment rather than funding private providers to provide healthcare.

Our challenge is that we cannot pick and choose when it comes to the delivery of health. For the person on the receiving end, that is their number one priority. It is very hard to say we should put funding into one area rather than another. We have called for what is in place but is not being honoured in respect of our INMO colleagues, namely, a staff safety framework which would allow services to be delivered based on the safe provision of staffing. Those figures are based on individuals, the acuity of the care required, the number of patients, the type of service and so on. That would allow someone the comfort whereby their work environment is one that is deemed safe by those measures. That contrasts with the current model for many grades, which is based on expenditure and money being allocated to an area and spent accordingly. That is what our submission today calls for. I will give an example. We called out some of this earlier. Support staff grades include the cleaners who keep the hospitals clean, porters who transport patients, catering staff who feed the patients and so on.

There are over 10,189 whole-time equivalents within support grades. For the last 18 months, that figure has gone up 19 across the country. Our members do not see the additional expenditure that has been allocated to health impacting them in their job on the ward, in a kitchen, in a porters' department and so on.