Dr. Peadar Gilligan:

I thank the Chairman and committee for affording the Irish Medical Organisation this opportunity to set out the views of doctors in Ireland on the future of Irish health care. As the committee is aware, the IMO is the representative body and trade union for the medical profession, representing all categories of doctors, including non-consultant hospital doctors, community health doctors, public health doctors, general practitioners and consultants. The experiences of the medical profession in Ireland have informed our submission to the committee. The development of a caring and effective health service is core to the mission of the IMO.

The written submission made by our organisation to the committee provides recommendations on a wide range of health service activities. However, I would like to focus the opening statement that Dr. McGarry and I are making on central aspects of the future of Irish health care, namely, capacity, staffing and the role of general practice. These are system-wide issues that, unless appropriately resolved, will inhibit development in other areas of the health service.

The media coverage of Irish health care frequently centres on hospital care, particularly emergency department overcrowding. As an emergency medicine consultant, I have been witness to the very real impact on patient care that cuts in health service funding have had. Our ability to provide high-quality care to patients in a timely manner is truly compromised in Ireland, as manifested by admitted patients spending in excess of 12 hours in emergency departments following a decision that admission is necessary and the increasing waiting lists for planned care delivery.

One of the most significant reductions made within the health service was to bed capacity. The effect of this is evident in every acute hospital in the country on a daily basis. There are in the region of 12,800 acute beds within the hospital system, 800 fewer than in 2007. Of these, 10,800 are inpatient beds, 1,300 fewer than in 2007. Contrast those 10,800 inpatient beds with the 14,700 inpatient beds which, in 2003, the Department of Health said we would need by 2011, or the approximately 14,600 inpatient beds we would have if we adopted the west European average. To put it bluntly, acute beds currently available within the acute hospital system are too few to provide care to patients in a safe manner. Unless urgent steps are taken to remedy this shortfall, many will continue to experience significant delays and preventable deaths will continue to happen.

We have heard repeated promises of a bed capacity review but no action appears to have been taken. Such a review is needed to determine precisely how many and what types of beds should be placed within the acute hospital system to provide adequate capacity on a medium to long-term basis. In the short-term, however, inpatient beds must be restored to the system at a faster rate than is currently the case.

Deficits in medical staffing restrict patient access to care and the quality of that care. The 2003 report by the national task force on medical staffing - when applied to our current population - sets out a requirement for 4,400 consultants in the health service. Today, however, there are just over 2,700, and as a result we have long-waiting lists for outpatients and procedures across virtually all medical specialties.

Comprehensive manpower planning must be undertaken to develop a consultant-delivered health service. At present, however, we are being forced to cope with a grossly understaffed hospital system where the patient experience of care is not as their doctors would wish. Consultants and non-consultant hospital doctors, the next generation of consultants, are being pressed into excessive levels of service provision which jeopardises patient care through the generation of unacceptable clinical workloads. It is little wonder that few doctors see working in Ireland as an attractive choice or one compatible with their professional development. Accordingly, we have one of the lowest numbers of practising doctors per capitain the EU, at just 2.8 per 1,000 of population, compared to an EU average of 3.4.

As a direct result of a failure to honour consultant and trainee contracts, public sector cuts and the further catastrophic 30% reduction in salary to all new consultants imposed in 2012, there are in excess of 250 unfilled consultant posts in Ireland, with one quarter of advertised consultant posts receiving no applicants. This does not augur well for the future of hospital care in Ireland. Irish-trained doctors continue to leave the country in significant numbers. Figures gathered by the OECD reveal that Ireland has the highest reliance on foreign-trained doctors of any country in the EU. Our research has found that just 40% of Ireland's medical graduates plan to practise here, while studies by the Medical Council demonstrate that health service understaffing in Ireland is the leading reason why our doctors are leaving to practise abroad. Unless the issues of adequate acute hospital capacity and medical staffing are satisfactorily resolved, we will struggle to fill medical posts in our health service.

Inadequate resourcing of hospitals in Ireland has compromised patient care and, as a result, patients, and the staff caring for them, are suffering. There are also significant challenges for our colleagues in general practice, a subject which Dr. McGarry will now address.