Seán Crowe (Dublin South West, Sinn Fein)
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The witnesses are all welcome. I am frustrated as they are, having listened to the members today talking about the lack of data and the fact the commission had to go out and create its own evidence, which seems bizarre and reflects on the service. It did not make it any easier for the commission to try to carry out the work it was being asked to do by the Government. There were a lack of availability of essential data, low-response rates and a lack of consensus between employers and employees. Therefore, the commission had to gather evidence externally, which caused difficulty, but how can it arrive at the conclusion in that case that some areas are facing recruitment and retention difficulties while others are not if it does have those data?

The Minister for Public Expenditure and Reform says it is not a pay review but rather a pay-related response for some areas but not for others, where allowances recommended for some areas but not for others. If one does not have the full picture, one gets the impression that this needs to be done. As the representatives said, there appears to be a lack of evidence that recruitment and retention issues were examined in detail. In the couple of minutes remaining, will the witnesses provide details of the health service employer engagements that took place and what grades were examined in detail?

Given the issue of pay inequality across the public sector, including in healthcare, is there a case for restructuring the payscales to make entrance more attractive, while avoiding inflating wage levels? Junior doctors and entry-level consultants seem to be paid far less while also working harder. Is this unsustainable and does it perpetuate the idea that there are unattractive arrangements at that level, thus turning people off? What kind of cost-of-living measures are needed to address that? Deputy Kenny referred to the London rate. Should there be a Dublin rate? There was a meeting over the summer with child and adolescent mental health services, CAMHS, in Ballyfermot, where people were saying that part of the problem was where people could stay or where they could live.

They are living two or three hours away from Dublin. That is not sustainable. In other jurisdictions the accommodation comes with the job. That may be something to consider. How does the reliance on agency staff affect retention and recruitment because that is part of the difficulty?

Even today, when the Taoiseach was asked about the number of nurses in the system he said that compared with other jurisdictions we have more nurses per bed. Nurses do not only deal with patients in bed. There is a range of issues for which they are needed. There is almost a denial that there is a crisis in the service. This was debated in the House last night. Did the witnesses pick that up in their inquiries?