Dr. Peadar Gilligan:

As per the 2008 contract, consultants are answerable to hospital management and their clinical directors with regard to their private-public ratio. The Irish Medical Organisation is aware of consultants having regular meetings with their management to be advised as to their public-private ratio and their adherence to same. It is worth repeating that 83% of patients seen in public hospitals are in fact public patients. The Deputy made the point that public hospitals should be for public patients. I put it to him that public hospitals should be for patients. I thank the Deputy for acknowledging that primarily the issue for the system is the lack of capacity within it.

With regard to consultants fulfilling their contractual obligations, as per contract law all employees should fulfil their contractual obligations. Equally, the employer has a role with regard to fulfilling its obligations under the contract. On the Deputy's second question about recruitment and whether the offering of type C contracts would help in this regard, the reason we have a problem with recruitment to consultant posts in Ireland is that it is unfair. By that I mean, since 2012 consultants appointed are remunerated at a lesser level than their pre-existing colleagues who are also paid at a lower level than their contracts stipulated. For both of these reasons, we have a huge problem recruiting. There is an issue of trust at senior doctor level with regard to their employer and the lack thereof because of the fact that the contract has not been honoured, the cuts superimposed on the failure to honour that contract and the disparity in payment depending on when the appointment was taken up. Those issues need to be addressed in order that we can recruit to consultant posts.

With regard to the clinical director question and whether the role is working, my response is that the role can work and work very well. We have seen examples of this throughout the country. The challenge, as acknowledged and stated by our colleagues in the IHCA, is that this role is not supported to the extent it should be. For example, they do not have the business managers that they need and they do not have support within the management structures of the hospital and as well as being clinically busy individuals, they also take on this management role. The role needs to be more supported than is currently the case.

On Sláintecare and the untangling of private and public care, as already stated just because a patient has private health insurance does not mean he or she should be disadvantaged. Equally patients without it should not be disadvantaged. To address this, we need adequate capacity within the system. On a daily basis, as an emergency medicine consultant I am in the fortunate position that whether a patient is private or public makes no difference to me in terms of the care I deliver. I deliver care on the basis of a patient's clinical need. I would want a system that allows this to be the case. Sadly, in that same role I see patients who are disadvantaged by the system and the under-resourcing of the system. We know from a recent survey of in excess of 11,000 patients and their experience of the hospital system in Ireland that only 30% of them managed to get through the emergency department and into a ward bed within the six-hour limit that has been set. That is a national disgrace. Across the water in the NHS 95% of patients can expect to be either admitted or discharged from the emergency department within four hours. The NHS also has capacity issues but not to the extent that we do. It is a huge frustration to consultants and senior doctors in the system that we do not have the resources that we need to provide care in the way we would wish to provide it.

On Deputy Kate O'Connell's questions, from the "Prime Time" programme we know that three doctors allegedly were behaving in a manner whereby they were not fulfilling their contracts. As explained in our opening statement, there are different types of contracts. There are doctors who are on part-time contracts and doctors who have rest entitlements given the onerous nature of their work. We know of only three doctors who it is alleged were not fulfilling their contracts. The experience of the IMO is that our consultant members are working well in excess of their contractual requirements. We sometimes become aware of this because their employers are failing in their delivery of the entitlement of a consultant, for example, with regard to on-call work and entitlements with regard to rest relating to that.

Deputy Margaret Murphy O'Mahony asked why it took an RTÉ programme to highlight this issue. With regard to the issue of, for example, a patient having to wait for a protracted period and having to make an out-of-pocket payment for the delivery of care, this is an issue of which, as doctors working in the Irish health system, we have been aware and by which we are disturbed in reality. It should not be the case that because a patient does not have health insurance or is not in a position to pay for his or her care that such care is significantly delayed. That patients with hip osteoarthritis, which is a very painful condition, are on waiting lists for two years should be a matter of national shame and should be addressed but this requires resourcing of the system. The Deputy asked about temporary contracts as compared with full-time contracts and their implication for delivery of service. There are excellent doctors employed as consultants on a temporary basis in the Irish system. The challenge for them is that given the temporary nature of their contracts, they will largely concentrate on service delivery as opposed to the strategic development of their service, which is an absolute requirement to try to move things forward. It is not a position in which most of those doctors wish to find themselves.

With regard to the conflict created by the National Treatment Purchase Fund in comparison with the public system, it has always been the IMO position that funding allocated to the National Treatment Purchase Fund should be used to provide for care in the public system. We should not a situation whereby we are paying private institutions to provide care in the public system because of an under-resourcing of that system. We would like to be in a position to provide that care to public patients within the public system and, as previously stated, to all patients.

The Deputy also asked why such practices occur, on which our colleagues on the IHCA touched. It is hugely frustrating for a consultant with many years of training, having made a huge personal and family sacrifice, to arrive at the level of expertise he or she is at and find themselves unable to access clinics and theatre space and time. That frustration may sometimes be evidenced in the manner that we saw. That should not be the case but it may sometimes be so evidenced. We need to have a system wherein consultants are fully employed and have available to them the required operating theatres, outpatient clinics and beds to admit patients on the basis of clinical need.