Mr. John Connaghan:

I thank the Minister. The Senator is correct that we should be prudent about spending any money that takes away from front-line services. Let me make members aware that we have a business case process for the appointment of any senior executive or manager and such appointments are the subject of a very vigorous business case and the approval process is shared with the Departments of Health and Public Expenditure and Reform. Members have commented on the growth in staff numbers in recent years. We have created delegated units in community healthcare organisations, CHOs, and in hospital groups and it is important that we staff these appropriately in terms of governance.

It is useful to refer to other countries in terms of a comparison with where we are. The experience in the NHS in England is that the senior management cohort is about 5% of senior and middle management and that compares exactly with the current Irish figure. The percentage of very senior managers in the HSE is less than 1%.

I will take up the point the Minister just raised about where administrative and clerical staff take on tasks that used to be done by clinicians. There is a scarcity in some clinical specialties and it makes sense to try to divert some of the non-direct clinical services task to the administrative and clerical function. That is a good thing because it allows clinicians to run at the top of their licence.

Let us look into the future. We have just been allocated €250 million from the European Investment Bank to bring forward our plans to create more in the way of electronic healthcare records. In order to bring that forward, we will have to add some of the specialists, the programmers, the system developers and the support staff. That might be for a transitory period but as I look into 2019 and through to 2021, I anticipate some growth in the management posts to enable that to happen.

I will ask Dr. Colm Henry to say a brief word on recruitment.