James Reilly (Dublin North, Fine Gael)

I thank the Deputy opposite for raising this and I accept her concerns. However, different areas require different skill mixes. There is some rather bad mismatching of some of our services at the moment. I was examining our situation vis-À-vis nursing ratios to health care assistants in some of our community nursing units. In some cases the ratio is not even 1:1 and there are more nurses than care staff. The Royal College of Nursing in the United Kingdom recommends a nurse to health care assistant ratio of 1:2.5 for long-term nursing care units. Many areas have different staffing ratios and one would need to examine each area individually to set the limit under which one would not be prepared to go. A one-size-fits-all approach throughout the system is not possible. There will be different ratios for emergency departments, cardiology, intensive care, paediatrics, ICU in paediatrics and so on. Different ratios apply in these cases. This is work we could do and it should be done. We will consider it.

There is a significant issue in respect of the skill mix in the country. There are varying ratios of medical and nursing staff in various emergency departments. Often it is suggested that one is not comparing like with like and that it is a question of comparing apples and oranges because of the complexity of injuries and disease that some departments deal with vis-À-vis others. However, the bottom line is that agency staff are remarkably expensive and, as someone who has worked in hospitals, I am aware that they present a problem in respect of continuity of care. I would far prefer to see and to make it our policy that where we recruit staff for replacement, they will be new, permanent staff. Issues have been raised with me in the past about whether many retirees will be coming back into the system. This is not our intention and it will be very much the exception rather than the rule.

See this speech in context