Mr. Andrew Condon:

On the issue of why doctors must rotate, as raised by Senator Burke and Deputy Ó Caoláin, the report from last year made some useful suggestions. In the intern year, students tend to work in the one location, so during different periods they follow different specialties in that one location. At other training levels, such as senior house officer or registrar, training is split into basic specialist training and higher specialist training and those doctors have a training agreement with their training body. There is, however, a huge degree of flexibility as to where they might fulfil that training agreement and they have a level of individual choice and determination with the training body as to where they can rotate to.

One of the issues is the extent to which the training body can give a doctor a training agreement at the start of the training programme that states where the doctor will be for the next two years, and in terms of higher specialist training, for the next four, five or six years and where the hospital's doctors will rotate to, along with the rotation dates. That will be the ideal scenario with a degree of flexibility built in.

There is a degree of flexibility at the moment and one of the conversations under way with the training bodies addresses how we give greater certainty to doctors and hospitals about who is coming to them and when. The health service is delivered by a variety of different employers. If I am a doctor in training at St. Vincent's Hospital in Dublin and I move to Cork University Hospital, I am moving from a HSE-funded agency to an agency owned and operated by the HSE itself. One of the measures we anticipate will deal with that is the transition to hospital groups that have independent governance. Another issue that will address that is the move to a shared service where instead of multiple payrolls that can lead to problems when changing employment, there will be a single payroll for the health service.

The key issue in doctors' working lives is that they know where they are going and how their career and training are oriented. We are taking that up with the training bodies.