Mr. Tony O'Brien:

I wish to be clear about the position of medical cards for children. Any child below the age of 18 years who has been diagnosed with cancer is automatically entitled to a medical card for a subsequent five-year period. That has been the case for two-and-a-half years. The standard process for a person above the age of 18 years has not changed in recent times. Discretionary medical cards are available for those with cancer. Should there be a diagnosis of terminal cancer – there is no crude timeline – there is an emergency medical card application process. There has been no policy change in that regard. If committee members are experiencing individual exemplars of some procedural change then we will look at them.

A question was raised about staffing numbers. Since October 2013 figures for medical and dental nursing are up by 9%, health and social care professionals are up by 21%, other patient care staff numbers are up by 24% and administration management is up by 17%. The administration management category ranges from the most junior grade, grade III, right up to senior managers. Some 85.7% of the total are in front-facing roles in care delivery settings. That reflects to some extent what the Minister was saying.

I made a journey around the health system, especially during the period when there was significant reductions in clerical and administrative posts. One of the key points made to me by health professionals, who were often in short supply themselves, was that what they most needed was someone to lift the administrative burden in order that they could focus more on the direct provision of patient care.

The number of senior managers represents only 1.4% of the total workforce. That is comparable with other health systems. Clearly, we need to have an overall strategic view on the right balance between the various grades. We go through a process each year that involves ourselves, the Department of Health and the Department of Public Expenditure and Reform. It centres on what is called the funding workforce plan and it seeks to address those concerns. The broader workforce planning process has been outlined and published by the Department of Health.