Bernard Durkan (Kildare North, Fine Gael)
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The next issue is the staffing levels and the configuration of the staff. I came across a situation recently where there was only one doctor available in a hospital. I do not know who decided that. I do not know how that came about but it should not happen. If that is the way it is, there is a reason for it, we need to know what is the reason for it and we need to do something about it. It is not a complex issue. It is a simple issue.

If there were 80 patients waiting in a hospital area on Monday of last week, the presumption is that there would be a similar number next week and the week after unless something is done about it. This is the problem. We spend our time talking about this and going over and over it which is detrimental to those working in the service but we do not seem to identify the cause of the problem, and the cause of the problem has to be addressed.

From my own observation, we went through a hiatus in this country over the past ten years. We went from a situation where almost 0.5 million people left the country and services were closed down due to very serious financial issues - there was no way around that and we were told what we had to do and we got to do it - to one where those people have come back with more. If one tours around the various industrial hotspots of this city and the country in general and looks at the volume of heavy traffic on the roads in the morning about which we complain, the answer to the question as to where are all the heavy trucks coming from and what are they doing is that they are doing their business. They are producing for home consumption or for export, whatever the case may be. It naturally follows that the health service must compete and cater for a much bigger market than it did 11 or 12 years ago. If we do not do that and we do not identify the most immediate issues upfront, we are missing out and we will talk about it forever.

I should say that I am a strong advocate of community care. I was a member of a health board in the past. I believe it was a better system because the inspiration for the response came from the ground up where the GPs were involved, where the pharmacists were involved, where the nurses where involved and where the psychiatric system was involved. Everybody was involved in a consultative capacity at the coalface. That is all gone and it is now centralised. The theory is that centralisation is a more effective and efficient method for delivering services. It is not.

This is the last point I want to make on that. I refer to recruitment and attraction to the system. I see no reason we cannot have temporary appointments instead of agency staff. The temporary appointment - while waiting for the permanent appointment to be approved - could fill the space, provide the service and deliver the service to the public which is what we are supposed to do. We are not an employment agency. We are deliverers of service. We require employers to deliver the service. Unless it becomes policy to utilise the temporary appointment, we are at nothing. I am not asking Mr. Donnelly to make a political statement on this. That is my view on it and I would like to hear the counter view.