Ms Eilísh Hardiman:

I concur completely. In fact, we have a staffing plan that has identified increased staffing, which needs to be funded every year through the Estimates process, as an investment in paediatrics. We have based that on evidence from comparable international services. Nobody disagrees with us on whether we have identified deficits. Within Children's Health Ireland, we have identified where our priority areas for investment are. We know we cannot do it all in one year. We have clearly worked across all three hospitals with clinical directors, nurses, managers and the head of the health and social care professionals and identified and prioritised our areas for investment. I am happy to say we have had the largest investment in paediatrics in 2018 with an additional 173 posts coming into Children's Health Ireland. The vast majority of those are clinical posts and we are working hard there. However, we are cognisant of the need for further investment and will identify that as part of that annual investment process. All of that has been identified in our future workforce plans.

We have a challenge in that there is only so much capacity within the existing hospitals. We are in a very challenging area at the moment. If one walks around Temple Street Hospital, one will see that we cannot squeeze anything else in. That is why people welcome the investment in the new facilities. They are not seen as being in competition. We are seeing it as taking some of the pressure out of Temple Street in particular so that we can concentrate on tertiary, high-end services within the hospitals and get general paediatrics, orthopaedics and other services out to Connolly Hospital, which will help greatly. We are looking at strategic alliances through the National Treatment Purchase Fund and others over the next few years as we will have to increase our workforce. We cannot leave it all to 2023 to do a sudden leap.

We have an evidence base with our waiting list whereby there is a requirement for further investment. With the HSE and the commissioning team around children's health, we have mapped out what we think we need, including identifying the pipeline and whether we can realistically fill these posts. Some of that means we have set up a whole workforce planning group with the HSE. We have established specific sub-committees on nursing because of the quantum of the numbers involved. We have identified a clear action plan for the supply and demand in nursing. We have worked up something with our colleagues in the doctor training unit on the future, in particular for specialist registrars and having a pipeline there. We have sought to identify colleagues who have left the country and would return if they saw the investment taking place. We are making some progress although it is slow and takes time. There are niche areas in which it is particularly challenging to fill posts. We want to work also with health and social care professionals. While they are not among the cohorts with the highest numbers, there are still a lot of them. There is, therefore, a need to ensure we have a pipeline and, when they come to us, that they have somewhere to work. It is complex but while the board continues to engage with colleagues on the build project, we have very much moved from the building to issues around staffing and ICT. Those are our major areas of focus to try to deliver a good service when we get the building.