Mr. Ian Carter:

If we start with NCHD staffing, there are currently 4,900 NCHDs employed across the 48 hospitals. The majority - I believe around 80% - are on recognised training schemes. Generally, there is no recruitment issue or difficulty in that context and, in fact, there is quite a degree of competition to get onto those schemes. Therefore, the main recruitment issue lies with the hospitals without training recognition which are employing service grades. In terms of the issues raised by the Senator, a survey of NCHDs identified three main concerns. The first was working hours, with certain NCHDs working very significant hours. The second was a perceived lack of training and support, either from the medical school or from the consultants, and the third was a concern about career opportunities.

In terms of moving forward this year, an accelerated effort was made last year and in the first three months of this year to reduce the number of working hours for NCHDs. Last year the target was 68 hours and our target by the end of this year is to be compliant with the working time directive, at 48 hours. The main piece in the last three months was removing the requirement to work shifts of over 24 hours, and that has happened. The other piece in terms of actions this year is to move away from automatic reliance on NCHD deployment and to start, in certain instances, to replace the NCHD workforce with a direct consultant workforce, particularly in areas such as anaesthesia. The aim would be to also increase the number of training posts, thereby increasing the attraction. We are setting a trajectory that our workforce will have some degree of stabilisation by year end, to be achieved by working-hour reductions, consultant replacement and certain tasks being undertaken by the nursing fraternity. However, it is still an area of tension and difficulty. There are active international recruitment campaigns going on to try to attract our extremely good medical staff. This is about us making sure we can retain staff while also recognising that many other Western countries are conducting very vigorous recruitment campaigns.

On the question of the recruitment of consultants, at hospital group level we have been examining the posts for which we have had difficulties recruiting staff with a view to restructuring them to make them more sensible and attractive. That is happening in some of the smaller hospitals in particular, where, without a link to one of the national tertiary centres, the post is unattractive. That is true of at least 25 posts as we speak. It is felt that this will yield an attractiveness which will enable us to fill those posts.