Regina Doherty (Meath East, Fine Gael)
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I thank the witnesses for attending. I have 12 questions, and while they may seem antagonistic, I do not mean them to be. It is a great pity we do not have the other people here so that we could put opposing questions to them. With respect, it is an IR issue, because all the concerns the witnesses raised existed when they sat down to take out the first €213 million that some mad loony agreed to take out of health under Haddington Road last October. While the issues may be exacerbated when we seek to take out the extra €80 million, they are not new.

Due to my ignorance, I have many questions on the research. Compared to other EU or OECD countries, Ireland has one of the largest proportions of nurses per 1,000 people. I have great respect for Professor Anne Scott, who is a neighbour in my village. She stated that to increase the patient-to-nurse ratio in the field of service would increase mortality by 7%, but, although we have done that in the last number of years, through no fault of the witnesses', our mortality rate has not gone through the roof. It is not very much different from other countries which have fewer nurses per 1,000 patients than we have. It all boils down to the skills mix. Mr. Doran said he would love to know where the plan is because he does not have the evidence. Somebody, somewhere must have the evidence of best practice in skills mix.

We spend much more than everybody else but still complain about it. Pick a country that spends a relatively decent amount of money on its health service, gives a good service and has a good skill mix, and put it in a matrix to compare it to ours. Please tell me somebody, somewhere, has done that. When the witnesses meet at the beginning of the year they should all have the same sheet of paper that says the best practice is, say, 10:1, the INMO wants it to be 11:1 and the HSE wants it to be 9:1, and they can argue over it and meet in the middle. I am hearing that there is no such piece of paper, and, therefore, the discussions about where to pare off the €80 million are done with no statistics, analysis or evidence of best practice from an international or OECD perspective. If that is the case, how do the parties negotiate with no starting point?

As a patient, if I did not understand the difference between a nurse in a white uniform and a nurse in a green uniform I probably would experience no difference in care because of the superb quality of care given by undergraduates, trainees or nurses with 20 years' experience.

Is the skills mix we are trying to achieve to secure the best value for money such that we would not need to have a ratio of ten patients to one nurse, that we could have, say, a ratio of 12 patients to every nurse as long as the nurse had a trainee nurse working with him or her under supervision? I do not fully understand it, but is that the process Mr. Doran would have been trying to achieve in the negotiations that would have taken place in next 12 months which obviously have now been thwarted by the letter he received? If at the end of that 12 months negotiating process the same outcome was put before him that they are trying to achieve today, would he be happy with it? On what is he basing his organisation's best practice data? Are they on the basis of what his organisation's members are telling him, or are there other best practice analyses from Australia or elsewhere? I ask him to point me in the right direction. I cannot even find reports on the web because the OECD material is very confusing in that it appears one country can get away with having five nurses per 1,000 population, whereas we have a ratio of 14.5 nurses. Mr. Doran might help me in understanding it.