I propose to take Questions Nos. 138 and 144 together.
The responsibility for the management of the workforce in a given Health Service Executive, HSE, area lies exclusively with the chief officer of that area. However, in order to improve recruitment and retention prospects, my Department has put in place a number of important initiatives to meet the human resource needs of the health services.
Specific human resources initiatives in key areas such as pay rates, improvements in career structure and enhanced opportunities for professional and career development have and will play a part in increasing staffing levels. Overseas recruitment by health agencies has, over recent years, also contributed significantly to meeting the workforce needs of the health services, particularly in the medical, surgical and nursing professions.
There is a wide variation in the numbers of nurses employed in the health services of developed countries. Figures on a consistent basis are not readily available for cross country comparisons. Research by the OECD, OECD Health Data 2004, 1st Edition, in which the most recent comprehensive comparison between European countries was 2002, suggests that Ireland has one of the higher ratios, although countries profile their data in different ways.
The Irish health care system has traditionally been based on a large number of nurses. Other European countries tend to have systems where there is greater skill mix and grade mix involved in the delivery of health care services; therefore the ratio of nurses to patients is lower. The Irish health service is also moving in this direction and in coming years there will be a higher proportion of support workers, including health care assistants, involved in the delivery of care, freeing up nurses and midwives to concentrate more of their time on higher level duties and expanding the scope of their practice.
Nurse recruitment is a priority for the Government. The HSE reported that in the year ending 30 September 2004 an additional 561 nurses were employed in the health service and since 1997 over 6,300 additional nurses have been recruited.
The Department of Health and Children has made substantial investment in consultant numbers in recent years. The current number of permanent consultant posts stands at 1,947. The OECD does not collate statistics specifically relating to consultants but does, however, provide statistics under the heading of physicians which encompasses any doctor who is fully registered with the Irish Medical Council. In 2002, Ireland had 2.4 physicians per 1,000 population — OECD Health Data 2004, 1st Edition. Government policy is to substantially increase the number of consultants throughout the next decade. There are currently 4,034 non-consultant hospital doctors training posts in Ireland, the occupants of which are given the opportunity of proper skills development on the basis that many in this category will become the consultants of tomorrow.
According to the Irish College of General Practitioners there are approximately 2,600 GPs working in Ireland. According to the GMS payments board annual report of 2003, 2,181 of these hold a GMS or other public contract. My Department has been in consultation with the Irish College of General Practitioners and the HSE on the subject of addressing future manpower needs in general practice. In this regard, it was agreed that the number of trainees should increase by a total of 66 in order to conform with the recommendations of the Irish College of General Practitioners. This will be achieved on a phased basis over a three year period.
Given the large numbers of staff employed and the unique nature of the services being delivered, a coherent, strategic approach to workforce and human resource planning needs to be developed further. This should be aligned closely with strategic objectives and the service planning process. Planning for the development of new and existing services in the future must be soundly based on a robust and realistic assessment of the skill and human resource needs to deliver these services.
Enhanced skills mix by matching skills to service needs benefits patients and empowers health personnel to reach their full potential. This optimises their contribution to quality care. The continued implementation of the "Action Plan for People Management" has a crucial role to play in improving retention and reducing the turnover of skilled staff. The Health Service Executive will be centrally involved in the development of an integrated workforce planning strategy for the health sector.