Ms Phil Ní Sheaghdha:

To answer the last question first, there is research that demonstrates that the period of time spent on a trolley causes the patient to have poorer health outcomes and unfortunately that means the patient is more than likely to have a very poor outcome. That clearly is not good enough.

We sought the workforce plan as part of a dispute on the numbers of nurses and midwives employed in Ireland. We have a maternity strategy that determines how many midwives we should have per birth. We should have one midwife for 29.5 births. That is the science and that is to ensure safe delivery of care to the mother and the baby. We are now 220 plus midwives short of that target in all of our maternity units. It is a national figure. We know this. The plan was put in place to recruit 90 in 2017 and the remainder in 2018. The latest figure we have is that we are even further behind the 2017 figure than when we started because we have an inability to retain and to recruit. This year when midwives graduated, we had to argue with employers to give them permanent jobs in Limerick, Galway and Letterkenny - throughout the country - despite the fact that the Minister for Health at our conference guaranteed that every graduating nurse would have a permanent contract. That did not happen. We recruited 900 because post strike, we concentrated on the low salary for the new graduates. We have improvements to that, we explained that to new graduates. We told them the salary is increasing; it is improving and the Minister for Health has guaranteed publicly that they would get a permanent job. That led us to a situation in September where we had to argue, in many instances site by site, for the retention of our graduates, which is beyond comprehension.

The workplace plan does make a significant difference because those posts are funded and therefore the arguments about whether we can put the advertisement on the HSE website or whether we can recruit disappear. The funding is there in advance, there is a set number and one's concentration is on filling the numbers set out in the workforce plan. We had a very modest 1, 270 odd as a target for 2017. The numbers who leave versus those who are recruited always leaves approximately 67%, onto which one must add. If 1,000 nurses are needed, one needs to recruit 1,670 to reach 1,000 because the turnover through resignation and retirements requires that. Very disappointingly, in the staff nurse grade according to the recent census, the numbers recruited since last December are down for that very reason. The HSE will say it is recruiting nurses but what it will not say is how many left during the same period. The margin is quite significant. Consequently, one cannot take one's foot off the pedal for recruitment and retention in nursing and midwifery. It is just too difficult to recruit without obstacles that an employer puts in. If that is coupled with a moratorium or a pause, one will be going backwards for several years. Unfortunately, we will be going backwards.

As for the geographical areas, we have a lot of information from various hospitals. There is no doubt but that the HSE sites are affected to a greater extent. The voluntary hospitals, the section 38 agencies - the Mater, Beaumont, St. James's - use a much more sensible approach. They try to recruit and retain and have a bit more autonomy in doing that. In respect of the statistics comparing Beaumont and UHL, Beaumont's argument has always been that it is a tertiary referral centre for neurosurgery in particular, which requires a higher staffing level in some of its intensive care units etc. It does a good job of trying to recruit and the committee will notice from the trolley figures that it has also done a good job in respect of trying to reduce the trolley count by ensuring, lobbying and getting additional capacity in the community in various units around north Dublin and that requires funding.