I thank the witnesses for their presentation and the work they are doing. It is a difficult area. There are so many different areas in the health service, including doctors, nurses, care assistants, cleaners, porters and administrators. It is complex. One problem I see with the health service is that everyone is fighting their own battle. There is a huge problem. There is no team effort. I have come across a few cases where nurses were not given support when there was an adverse outcome. I was really disappointed when somebody recently came before the committee and spoke about the lack of support offered when there is an adverse outcome. That applies to administrative people, nursing staff and doctors. That puts people on the defensive for the rest of their lives. Their attitude is shaped by the experience of not getting support when they needed it. I am really worried about that in the health service. That has happened time and time again to people I know who work in the health service. We need to work on that.

This is not a criticism; it is just an observation. Since December 2014 the number of staff in the HSE has increased to 135,000. It has increased by 16,000 full-time staff. Meanwhile there is a perception out there that an embargo is in place and no new staff are being taken on. It is unfortunate that this impression has taken hold among the public as if nothing has been done. Actually 16,000 additional full-time staff have been taken on. That is a huge increase in staff numbers. However, during that five-year period there does not appear to have been a plan outlining which crucial areas needed more employees. It appears to have been a case of who shouted the loudest. That is my worry.

I will come back to the issue of administrative staff. This is not a criticism, because I know a lot of staff were laid off. The actual number of administrative and management staff has gone from 15,030 in December 2014 to 18,600 in March 2019, the last time for which I have figures. That is a 24% increase. I have no problem with that. My problem is that this was disproportionate. There was an overall increase of 17% in the number of HSE staff but administration and management increased by 24%. I have a problem with the fact that the number of public health nurses only increased by 3.7%. It appears that no-one was fighting their corner. Public health nurses play a very important part.

This is not a criticism of administration and management. However, it appears there was no plan which took account of numbers and of needs for the next 12 months or two years and determined how to use the budget. That is one of my concerns. I do not know the witnesses' views on that. It does not appear to have been a priority. The public perception is that there are fewer doctors and nurses but that is not the case. In fact there are more doctors. Comparing the current figures to those of 2009 shows that we have gone from 7,000 doctors in the HSE to 9,000. That includes consultants, the number of which has risen from 2,100 to more than 3,100. The number of junior doctors has also increased by more than 1,000. The number of care assistants has increased, which is a huge advantage because they provide a very good service. That number has increased by 2,000. I am still concerned. No-one is saying at the start of the year that we need an extra 500 care assistants. The increase seems to have happened in bits and pieces around the country. From their own dealings on this issue, what are the witnesses' observations? Some 16,000 additional staff is a huge number to take on without any overall corporate plan. Certainly if a private enterprise decided to take on 16,000 people there would be a clear two-year, three-year, four-year or five-year plan. That does not appear to have been in place. We need to set clear targets when planning. Let us talk about the targets first and then talk about how to resource them. We seem to be deciding to hire people on the basis of the money we have for a certain year. We need to do that far better than we have done. I do not know what the witnesses' observations on that are.