John Crown (Independent) | Oireachtas source

The issue is that this is the every day and every night experience of junior doctors all around the country where they are expected to work like that. They do something far more complicated than doing what a Whip tells them in terms of voting "Yes" or "No". They actually have to make life and death decisions. Deputy Ó Caoláin correctly pointed out the oddity of referring to them as non-consultant hospital doctors. Previously they were known as junior hospital doctors. However, when it became apparent that the average age of a registrar in this country was the late 30s and the average junior hospital doctor had ten to 15 years of medical experience, following medical school under their belt, and that on average they waited until they were in their 40s for a consultant job, which in any normal country, with a normal health service, they would have had a decade earlier, it became apparent that calling then junior doctors was inappropriate. This goes to the core of the problem. Trainees should be trainees. If I ran the system I would refer to them all as trainee specialists. That is what they are. Senior hospital doctors, interns, registrars, all with varying degrees of seniority, are there to learn and to train. Instead of that, we have used them as a colossal band-aid to plug the fundamental gap in our health service which is the appalling shortage of career level jobs both within and without hospitals. We have the smallest number of consultants in every specialty and the smallest number of GPs. As a result if people are to get medical care, one has to inappropriately use trainee doctors. As well as that there was a culture where our trainee doctors were encouraged to go to international centres of excellence to advance their careers and to bring skills back to our country.

Instead, I believe what has happened is that the domestication of training in this country has been an attempt to institutionalise people, keeping them here for four, five, six or seven years after medical school to be service providers. The royal colleges and, to an extent, the Medical Council, have been somewhat complicit in this.

I beg the committee's indulgence, but I may have to leave to deal with an issue in the Seanad. The key solution to these problems would be to have appropriate reform of the health system. People should know coming out of medical school that they will have to do this for five or six years, but that after that they will have a career level job. They should know there will be no pressure on them to emigrate or no uncertainty about the outcome. They would do their five or six years in that case. It is because we keep them in endless abeyance, not knowing whether they will be "junior doctors" or "trainees" when they are already a decade past full training that they tend to regard themselves just as service providers.

We urgently need to fix the safety issues relating to the non-compliance by the State with international guidelines and international and European directives. However, to fix the bigger picture, we must fix the health system. We must have a system where we have an approximate trebling or quadrupling of career level posts, a reduction in trainee posts, a match of career posts to trainee posts and a situation where, when a person finishes medical school and has done his or her training, he or she will have a job.