Dr. Grainne O'Kane:

I wish to echo Dr. Murphy's comments and I thank the committee for having us here this evening. I wish to put things into some context following what Ms Coulter has said. Seven years ago as a student I was asked to shadow some of the interns in a particular hospital and document the inappropriate tasks on call. The work was documented seven years ago but nothing has been done with those inappropriate tasks since then.

Senator Burke commented on management and NCHDs. I have come to realise in recent years that in Ireland there is a huge missing link between administration, allied health staff and NCHDs. Undoubtedly, we are best placed to serve people because we can see the inefficiencies in the system since we work on the ground. We are also well travelled and we have worked in various hospitals throughout the country. For such a small country we have a rather variable health system and things are done differently in different hospitals. As a result of these observations made over my five qualified years, two years ago I established an NCHD committee in one particular hospital for several reasons. Following this, we held several meetings with nursing staff and we progressed several issues relating to inappropriate tasks. We developed a collaborative document with nursing staff on a policy and we began to implement a pilot scheme on the administration of first-dose antibiotics by nursing staff. I believe that has progressed although there have been several teething problems.

We have another NCHD committee in my current hospital. We are working on several issues including inappropriate tasks and rosters. Also, we have NCHD representatives linking and infiltrating throughout the hospital. We now have several representatives on the HSE clinical programmes within the hospitals. We meet regularly with human resource and administrative staff to consider the issues involving NCHDs. A good deal of work has been done. In recent months, given the current climate we have advocated that NCHD local committees are potentially the way forward on a short-term basis. Certainly, one size does not fit all situations. I have worked in several hospitals throughout the country. If one implements a given roster in one hospital, one can be guaranteed that it will not work in another hospital.

This brings me to another point. Workforce planning throughout the country is something we should work to improve. Communication is vital but it is possible to improve things. The culture of Ireland is such that decisions that involve NCHDs are unilaterally taken by administrative staff. No one seems to consult the NCHDs. I believe that we are best served to consider the inefficiencies and to improve the system. Anyway, it can be done.