Dr. Emily O'Conor:

I will refer that question to Mr. Doran because I do not know the nursing reasons for moving from Nightingale wards to smaller wards.

On recruitment of consultants, pay is greater in Australia but there is a more significant point. In my department we see approximately 35,000 new patients a year. There were two of us for the past ten years and we have worked very hard and we hope to have five consultants soon. In a department of the same size in Australia - I know this because my trainees go to work in them - there would be 22 consultants, working 33 hours a week on shifts. While it is a question of money, it is also a question of working conditions. The starting salary in the UK is lower but there are significant increments as they go through their career. Being honest, the starting salary for new consultants is not enough. They suffered the special 30% financial emergency measures in the public interest, FEMPI, imposition. I have a young colleague working with me and with that 30% drop, it simply is not enough. The only people taking that contract at the moment are those with domestic responsibilities who feel they have to. That needs to be changed.

I am not an expert on the fair deal. I will pass over those questions.

In response to Deputy Murphy O'Mahony, yes, all emergency departments employ triage 24 hours a day, seven days a week. It is called the Manchester triage symptom and is delivered by trained nurses. Most places have a computerised system for that but some do not. The system is standardised and reproducible. We did not have a triage scale suitable for children but the emergency medicine programme has recently introduced the Irish children's triage scale, which is going national now.

In response to the question about the number of trainees compared with consultants, we have always run a pyramidal system where the top of the pyramid is very thin and the base is very broad. That is the tradition in this country and that is how I trained. We want desperately to overturn the pyramid so that most of the care is delivered by consultants with a few trainees coming through for experience and training. Consultants are expensive to train and employ and that will take investment but medically that is the way we need to go.