Mary Harney (Dublin Mid West, Progressive Democrats)

If we are to provide a proper service, we need to double the number of consultants. There are 4,000 junior hospital doctors and 2,000 consultants. The sum total we pay them is no greater than what we would pay were we to have 2,000 juniors and 4,000 seniors. From a financial point of view, the current situation does not make sense. We want to appoint all new consultants on the new contract rather than the current one, which is unique among the world's public health systems. Last week's much-quoted OECD figures show that Irish consultants in the public system get 4.65 times the per capita income. Senators can read about it in the report. It is not a matter of what we pay people but of how they work, particularly in terms of equality of access to our public system. There is universal coverage, but some people have preferential access.

The recruitment freeze was done for budgetary reasons, but it affects relatively few numbers. The HSE has granted some 300 exceptions for essential or emergency cases. Recruitment will recommence after Christmas, but we are entitled to expect that the HSE will live within a budget as large as €15 billion.

I feel strongly concerning performance indicators, which have been introduced for hospitals by the HSE. Professor Drumm's summer announcement of more than 100 consultants is based on hospitals' performance. Those that perform will get more whereas those that do not perform well will get fewer.

Liaison nurses at Waterford Regional Hospital were referred to. That hospital has one of the country's best nurse-to-patient ratios and is one of the most efficient, but hospitals that do not do as well have much higher ratios. We want to reward the good performers.

Our health care system has the highest number of nurses in the world. I am told that there are no liaison nurses, but it is a matter for management to decide what nurses do. I want to keep as many nurses nursing as possible instead of moving them into management positions, but this may not be popular with nursing unions. I would like to reward nurses for doing the jobs they were trained for and are good at instead of allowing them to believe they must move. It is like other areas of life where one must move away from what one is good at to be promoted up the ladder. We must address issues in that respect.

There are considerable variations in bed stays between accident and emergency units. In the case of an appendix operation, one may be in hospital for two or three days or for a week, depending on the hospital. One thing is certain, however, if one is in hospital on a Friday, one has a 90% chance of still being there on Monday morning.

Money is being allocated hospital by hospital on the basis of performance indicators. The HSE has sent clinical and management experts to some of our hospitals, the results of which have been encouraging. A person is sent to work with the hospital instead of blaming or penalising it, which is a good approach.