Mr. Éamonn Donnelly:

There is a fairly complex answer to those questions. I will try my best. Before I came back to the health sector in the trade union movement, I was actually in the Civil Service. They spend a disproportionate amount of time trying to analyse performance. Do I believe there should be performance accountability in the Civil Service? Absolutely, yes. We are on record as the only trade union to offer ourselves up for that. Every St. Stephen's Day I hear on the radio that there are 672 people on trolleys and straightaway the hospital manager is blamed. How can a hospital manager in that capacity stop 672 people being on trolleys when it is a systems failure? I would rather for that hospital manager to be protected by a performance management and accountability system; it would make more sense. That should apply to workers.

It is quite simple with health and social care professionals. At the turn of this century in 2000 there was no career structure whatsoever because a physiotherapist was a physiotherapist and an occupational therapist was an occupational therapist. Speech and language therapy barely existed. When people had strokes they were almost losses to society. The world has changed and we have the skills available. As a result of our co-operation with the new community health structures, we are in the process of reviewing the career pathway for health and social care professionals.

We should not underestimate how important it would be to see automatic progression from basic rate to senior grade therapist because it touches on some of the things the Deputy has mentioned. It must be validated that the therapist is competent so it is linked to performance. I will use the example of Leitrim and Longford again. Someone there may have developed a four or five-year relationship or connection with patients. All of a sudden in order to access a senior grade he or she probably has to go to Sligo to follow where the population is to get on a panel and so on.

We are trying to convince our health and social care professionals, apart from the value to the patient of clinical specialisms, advanced practitioning, that maybe at some stage in their career they might need to say, "I'm going to actually use my expertise and put down my tools. I'm actually going to populate posts that are responsible for service planning and delivery. All this stuff you talk about in terms of how you view a service, I'm going to bring my clinical expertise to this." We then need the creation of directorates for the various professions. If we had a vision set out like that, remaining on as a health and social care professional in this country would be a more attractive option. Many of our people look the British National Health Service, NHS. It is not quite like nurses and doctors where potential hospital consultants go to Australia; our people tend to go to Britain. We could stem that tide very quickly if we had a pathway mapped for them.