Dr. Matthew Sadlier:

As someone who has worked in the health service for 19 years I would say it is a question of improvement not reform. We have had so many reforms that I sometimes do not even know who I am working for. I started working under health boards, then the HSE, then pillars, then community health care organisations and integrated service areas. It is a question of incremental improvement to the services rather than another broad scale reform of the services. That is my first visceral reaction.

To improve the services we have A Vision for Change for mental health care. I would argue that mental health care has led out the Irish health care service for a long time. There was an inspector of mental hospitals a long time before the Health Information and Quality Authority, HIQA, was ever thought of to inspect general hospitals. We have had reports on how the mental health care services should be organised since the late 1960s. There was Planning for the Future in the 1980s and A Vision for Change in 2006. It is a question of implementing the reports that are there. The structures in A Vision for Change are excellent. We divide the country into catchment areas. There is a service that is accountable for every area, with community mental health care teams, whether for adults, old age or children. The difficulty is in staffing those teams, the recruitment and the retention.

I cannot overstate how much damage the 30% cut to consultants' salaries, which was introduced unilaterally in 2012, inflicted on the Irish health care service. It was felt by trainee doctors at the time as a direct assault on them. We had experienced FEMPI cuts and cuts for new entrants across the public sector and various changes in terms and conditions but this one cut was imposed on one grade for reasons that nobody could really understand. Nobody could work out what due diligence was done at the time or what were the expectations of this. Since then we have gone from a system where consultant staff were easy to recruit. The first consultant interview I ever sat for was in early 2012 and there were 37 applicants for three consultant posts in north Dublin. There are now 22 vacant consultant posts and nobody applying for them. That problem has not been solved. There are three different salary scales for consultants. People see that as a direct assault on them, their training and their expertise and they are unwilling to take a job where they will be working side by side with somebody who has the same level of expertise and responsibility and is expected to deliver the same workload but at a significantly different rate of remuneration. Nobody would take up those jobs in a private company.

There are other issues in respect of funding training and education for non-consultant hospital doctors, NCHDs. They used to have a training grant but now they have to self-fund a lot of training which is becoming more expensive. They have to pay for various things out of their own salaries. That could be improved by comparison with Australia and Canada where our doctors are going. We work in an English-speaking health service and compete with New Zealand, Australia, Canada, the United States and the United Kingdom. Other countries seem to have done better on issues regarding training and education and work-life balance.

Junior doctors here are still expected to work outside the European working time directive limits and we have difficulty in applying the maximum 24-hour shifts. Junior doctors will not put up with such conditions any more when they can get better conditions in other places.