Mr. Liam Doran:

Yes. It was on layering of management and the grades of the management structure. It is our view that the management structure is multi-layered now, although not at the front line where the grade 3 and 4 managers are essential. When one goes away from that into other areas, there are many layers of management. The expressions-of-interest method of filling posts is bedevilling the health system at the moment. In fairness and with respect, however, that is another by-product of the embargo. It is trying to circumvent the embargo by asking for expressions of interest. Expressions of interest may not deliver the best person for the job, which is a further weight upon the health service. We all want to be led by leaders and those who challenge us every day. We do not have an automatic right to be right, but my problem is that I do not know where we are going. Surviving the budget is the only thing that matters at the moment in the health system. There is no manpower plan.

Before I say "Thank you" to the committee, I acknowledge that Deputy Pearse Doherty started by saying it was an IR issue involving €230 million, but I say with total sincerity that the Haddington Road agreement does not talk about a 40:60 skill mix, substitution of support interns for qualified nurses or putting Ms Grace Murphy into the community when she qualifies. This plan mentions those things, however. We did not sign up for this, which is a horse of a different colour. That is why we are against it.

We say genuinely to the committee that we have asked it to examine a few options at the end of our submission. We do not believe this is an IR issue, but that we are now cutting bone in the health system. It is not just a case of vested interests wanting to protect themselves. We will develop the role of the nurse, but we must have enough of us to do so. We want primary care and all of those things, but this plan is the last way to go about it. It must be reviewed.

On behalf of the INMO, I thank the committee very much.