Mr. Martin Varley:

I will address a few of the earlier questions. Deputies Billy Kelleher and Kate O'Connell raised questions vis-à-visdeference to consultants and what can be done to address the recruitment crisis. On deference to consultants, in the past ten years in my position, I have never observed deference of the sort referred to. I think the opposite has happened. Certain aspects of the contract are not being adhered to by employers and, dare I say, by the State. There are major issues, one of which is subject to a High Court hearing, vis-à-vis the salary component. Even aside from that, there are other aspects where consultants work half-days and full days on Saturdays, Sundays and bank holidays when they are on call and it has taken the best part of a decade to get some hospitals to start to pay consultants in accordance with those working conditions and terms of their contract to the extent that we have consultants working eight or nine-hour days on Saturdays, Sundays and bank holidays and not being paid in accordance with their contracts. I know of no other employment in the State where that would happen and would have persisted for the best part of a decade. That unfortunately feeds into the recruitment and retention crisis.

We have extremely mobile and highly-trained doctors, specialists who are in demand worldwide, even to the extent that 20% to 30% of graduation classes take up positions immediately after their internships in Australia, Canada etc. They are now moving in big groups. They are leaving a system that they see as being dysfunctional and leaving their senior colleagues without the basic resources to treat patients. They say they will examine elsewhere and are unfortunately actually staying there in greater numbers than before. They move from hospital to hospital and have very good career opportunities. More importantly, they have the resources to treat their patients. Two things are at play here, which are the lack of resources to treat patients and that contracts are not being honoured. Remuneration, as it happens, is more attractive in other jurisdictions.

What can be done? One basic and important thing is to honour agreements and contracts entered into with professionals. The day an employer goes down the route of breaking a contract is when it crosses a line and nobody can trust that employer thereafter. Unfortunately, in this case, people cannot trust the State and we are practically ten years past that breach. The second important thing is to end the discrimination against new-entrant consultants. They are on discriminatory salaries. They do like-for-like work with their senior colleagues. They are attracted abroad. Some take up positions in public hospitals then leave and go back into the private sector or abroad. Those are the two key components, together with, most importantly, providing them with the resources to do their work. Doctors, surgeons and consultants get very frustrated if they cannot treat their patients. Deputy Kelleher rightly asked about type C contracts and whether they are part of the solution. They are part of the solution but not the full solution. It relieves some of the frustration if one comes back into a position but has insufficient surgical operating time. One is young, is capable and can do more, is used to operating three days a week and would like to do it in one's public hospital. That person can do a certain amount in addition after completing his or her hours in a private hospital. It can work effectively, especially if we have a scarcity of consultants, as we have. Generally speaking, we have approximately half the number of consultants we need. In some specialties, we only have one third of what we need. It is only part of the solution. I suggest we continue to use it but let us not rely on it being the full solution.

We surveyed our members about hours a number of years ago. It is a little dated but the vast majority of consultants are working beyond their hours and the range, from memory, was between 5% and 50% above their hours. I suspect it would be even higher if we surveyed them again today. We are not counting in that the point that since the new contract came in, people are working structured, planned, half days and full days on Saturdays and Sundays when they are on call.

In the past the on-call status was solely to deal with emergencies, but it has now become practically a full day's work or a full weekend's work. There is no other jurisdiction where doctors and consultants are providing that level of input and they have bigger teams and are fully resourced numbers wise.

I move to the issue of insufficient capacity. The examples are country-wide. In Galway the two orthopaedic theatres in Merlin Park hospital were closed repeatedly due to an influx of water into a clean air environment month after month for a period of years. Inadequate resources prevent orthopaedic surgeons from operating. There is, in effect, no elective work being done there and that will continue for months.

In Limerick University Hospital until recently the isotope bone scanning equipment required to treat cancer patients was not working. It has been replaced and the hospital is now waiting for a physicist to be appointed in order that it can be used. The other major issue for consultants is rolling closures, whereby planned closures of theatres, as well as unexpected closures, take place owing to a lack of beds.

When we surveyed our members two years ago, planned closures were running at the rate of 10% in Dublin hospitals and between 25% and 35% in hospitals nationally. They were normal Monday to Friday working hours. Why were they closed? It was because of there being an insufficient number of beds. Doctors and consultants were willing to carry out procedures. We had an incident earlier this year in a major cancer hospital where on a Sunday evening 23 patients had procedures cancelled at approximately 8 p.m. Some of them were repeat patients who had experienced previous cancellations. The vast majority were cancer patients. Again, cancellation was due to there being an insufficient numbers of beds. The entire surgical team was available, but the cancellation happened at the last moment.

What we need is an investment plan for the health service similar to the one introduced for roads previously. We need a clear, well funded plan to put in place an additional 4,000 acute hospital beds to allow us to treat patients on waiting lists and avoid ever-increasing numbers of patients on trolleys. Looking at the figures in front of me, I note that most of the waiting list figures have doubled in the past three years or so. The numbers of patients on trollies have more than doubled since they were declared to be a national emergency and a crisis. The root cause of the problem is the lack of beds. In the €80 billion capital plan which is to be announced soon, if the health service is not provided for properly, the State will be condemning the population to an ever disimproving acute hospital service, not just for the decade 2018 to 2027 but for several decades to come. If we do not act now in the face of an obvious escalating crisis, we will miss the opportunity. I hope the State will put the necessary funding in place.

I was asked about the number of full-time private practice consultants. We think it is in the region of 400 and increasing.

Someone commented on the National Treatment Purchase Fund, the issue with which is that it is not a sustainable solution. We need basic capacity in public hospitals. While private hospitals can carry out more procedures, it is not the full solution.