Ms Shirley Coulter:

I will do so. I will take the questions in order and group them together, where appropriate.

Deputy Caoimhghín Ó Caoláin asked about the next steps and the compatibility of our views on the next steps vis-à-vis appropriate tasking with reference to nursing staff and so forth. We are not reinventing the wheel. There is already significant custom and practice around the country, whereby other grades of staff, not just nursing staff, are undertaking these duties and it is a matter of looking at where it works and developing national guidelines. These guidelines should be developed collectively. It is important that the HSE, the IMO and doctors work together, with the representative bodies for the other groups.

The committee may already be aware that the IMO works alongside the INMO, where appropriate. Both organisations left the Croke Park II discussions recently and are collaborating closely on many issues. We have had informal discussions about these issues. I welcome Senator John Crown's comments and agree that appropriate reform of the health system is absolutely necessary, but it is probably a longer term goal, given the major patient and doctor safety implications. We need quick win solutions and things to happen now. Some of the key measures we are examining will achieve this. One of them is the introduction of a maximum 24 hour on-site shift. Another involves the removal of inappropriate tasks.

As some of the doctors might like to speak, I will hand over to Dr. Murphy. Dr. O'Kane has been very involved in securing the local engagement required to effect real change in a number of hospitals and will speak about that issue after Dr. Murphy has contributed.