Dr. Peter Boylan:

With regard to the recruitment, it is not the case that there are 100 consultants who could be recruited to the service tomorrow. A figure of 10 consultants a year is realistic over ten years, plus replacements. They are not there, and we cannot train them quickly enough.

We do not want to appoint people into consultant jobs if they are not ready for it. That has been a big problem in the UK, where significant numbers of consultants are on gardening leave because of problems with their practice. We need to be careful to do it properly.

As we have heard, outcomes in Irish obstetric care are very good by international standards. That is in spite of, rather than because of, our staffing. It is also important to replace those who retire. This means that in addition to hiring ten new staff members, we must also replace outgoing staff members. Many people talk about the airline industry when they are making comparisons with safety. I do not think passengers would be happy if someone came over the intercom prior to take-off to explain that they are being flown by a trainee pilot who has been recruited because the regular pilot is unfortunately on holidays and to express the hope that as the trainee pilot has almost finished his or her training, everyone will get there safely. That is what happens in our sector.

The two trainees who left had exit interviews to see what the problems were. That is reflective of the pressures of the specialty. It should be pointed out that people leave surgery or paediatrics etc., to go into general practice when they realise that what they are doing is just not for them. It is good that they leave because we do not want people going through a training system, being unhappy at the end and then working in a system in which they are just not comfortable.

A question was asked about a lack of oxygen during birth. Birth is a hazardous process. That is why so much attention is placed on it. Advice is always available. Midwives always have the authority to go over the head of the junior doctor on call to the consultant on call if that is felt to be necessary. That should be welcomed and should be standard practice in every unit. That was certainly the case in any unit I ever worked in.

There has been no mention of Article 40.3.3°. The article has not been repealed. I guess things will change when and if it is repealed. Obviously, the institute will be available in terms of training doctors in relation to performing terminations. In the majority of countries where this is widespread, it is done in the community at less than ten weeks, and there is also the medical termination of pregnancy and the tablets we have heard about which are currently being imported. Obviously, that is something that would be addressed between ourselves and the community services etc.

It is blindingly obvious that folic acid should be in food. We should just get on with it. I understand there is some kind of problem with the importation of flour from England to make bread in this country. All these problems should be overcome.

I believe Dr. McKenna will talk about gynaecology. I suggest that a modification of the mastership model, along the lines of the development that is happening in the South/South West hospital group, represents the way forward for governance. I emphasise the real importance of having separate governance and a separate protected budget for women's health care, including maternity and gynaecology.

Reference has been made to the Australian system. I acknowledge one cannot import an entire system but one can import bits of it. Obviously, we would not do exactly the same things as Australian doctors. I think this is something that should be looked at from a specialist point of view when we are encouraging recruitment and encouraging doctors to stay in the Irish system.