Mr. Gerard O'Callaghan:

It is done as a group for our statutory hospitals and consultants, with our two voluntary hospitals doing their own recruitment. We are trying to introduce more flexibility for nursing. It varies between hospitals so we are trying to standardise what goes on across the group as well as having international recruitment to increase our numbers. We are recruiting but people are leaving as quickly as we are getting them in, which has been our problem. There are a couple of issues in regard to medical group recruitment. In our big geographical area the somewhat peripheral hospitals, namely, Kerry, Clonmel and, to some extent, Waterford are having difficulty recruiting consultants in certain areas. The cost of locums is twice that of hiring someone normally, so we are working hard to improve the situation. If we do not get permanent consultants, it becomes more difficult to recruit junior doctors, who do not want to work with these people. In addition, one needs accreditation for training but one cannot get that without a consultant. It is a catch-22 situation but we can address the financial issues by recruiting consultants to some of these hospitals. We are doing a lot of work behind the scenes in this regard. We are trying to get non-consultant hospital doctors, NCHDs, working in the peripheral hospitals as well as in the larger hospitals, and that should help the situation. Our locum costs in Kerry and Clonmel are extremely high.

We work with two community health care organisations, CHOs. CHO 4 is purely Cork and Kerry, which is ideal for both of us, but CHO 5 in the south east works with Ireland East and ourselves. It is working quite well and we have established fairly good management groups. Over the winter it is challenging to get people around the table to ensure quick discharges and to get community intervention teams and home care packages in place. We have almost daily communication with our friends in the community. It is not all plain sailing but there are structures in which we can work through the situation.