Colm Burke (Fine Gael) | Oireachtas source

I thank the panel for attending. I appreciate their work and acknowledge that they work in a difficult area. It is not easy to manage 4,700 junior doctors and its a different issue again to manage them in individual hospitals. I hope that anything I say is not taken as a personal criticism.

I shall follow the comments made by Deputy Ó Caoláin on emergency medicine. There is a major crisis in emergency medicine due to the expected shortfall of around 28%. The current figures state that Tallaght will be short two out of five, Limerick three out of six, Cork four out of seven, Drogheda five out of nine, Loughlinstown two out of three, Galway two out of eight and Castlebar two out three. There is also a major problem in the northwest region with a shortfall of around 80 in medicine. There are also particular problems in Letterkenny and Portlaoise due to a shortage of two out of three registrars in the obstetrics and gynaecology unit.

My other concern relates to the 2003 report. It contained a commitment that we would have 3,600 consultants by 2012 but we have only 2,500 consultants at present. Recently I got the figures on the employment of a registrar for six months which had a provision that positions could not be filled on 1 July. There is now a commitment to give two agency posts to registrars. The cost of the registrar for six months is €125,000. Should we return to the Hanly report of 2003 when reviewing the junior doctor process? Is it not cheaper to employ five consultants rather than have three consultants and four registrars? Should we reduce the number of registrars? We have not revisited the sector. The use of agency staff will incur great costs for the HSE and lead to an overrun in its budget. I agree with Mr. O'Brien's report that where the junior doctors are aware of shortage, they are leaving posts in order to fill them again under an agency contract.

The first issue is about reviewing this entire issue - in the smaller hospitals in particular - as to whether we should review the employment of consultants, as opposed to junior doctors. The second issue pertains to scenarios in which junior doctors have agreed to take posts but then have received a better offer from somewhere else. I understand this has happened in a number of hospitals in the past two months, whereby such doctors, having agreed to take up a post, have walked out of that post to take up another, thereby leaving the smaller hospitals high and dry. I raised the third issue, concerning the people who had come in from Pakistan and India, at a meeting last February, when I also wrote to the HSE in this regard. I was concerned that no procedure had been put in place to get them onto the general division of the register. I now understand that of the 300 who came in, only approximately 74 will remain in Ireland after finishing their two years. Do we need to learn what went wrong that of 300 people, only such a small number have decided to remain in Ireland?

I have a further issue in respect of training bodies. While 81% of junior doctors are in what are recognised training posts, there appears to be no co-ordination about such training posts, in that a huge number of doctors still must reapply after six or 12 months to continue in their rotation. Is there a need to meet the training bodies to tell them the current system is not working? Is it the case that there is a need to talk about a fresh approach to this issue? This system has been in place for the past 25 years and problems with it are being encountered. Moreover, on the administration side it also is placing huge pressure on the HSE and were it not necessary to spend so much time on such matters, the HSE could be doing many other things. Is a plan in place for the next two to five years in respect of dealing with this issue? While 2011 was a difficult year, 2012 was more difficult and at present, in 2013, no real improvement has been made in respect of the problem that arose in 2011.