Mr. Martin Varley:

A number of the most recent speakers raised questions about recruitment and resources, front-line resourcing in particular. This touches on the comments I wanted to make. We have two main problems from a service delivery point of view. First and foremost is a lack of front-line resources. I know we all hear we spend more on our health service than the other European countries. When we drill down into the figures, we do not see this level of resourcing presenting itself on the front line, so there is the question whether some of it is being lost, more so here than elsewhere, in administration, etc. The indicators for this are quite obvious, and we have already touched on them, namely, the number of beds, doctors etc. we have in the mental health services. The same applies to the acute hospitals. We have the lowest number of beds on a comparative EU basis across the acute hospitals and mental health services. We have the highest occupancy rate, at 95%. The recommended level is 85%. We are therefore occupying to a higher level. We have the longest waiting lists, as people have said, the reason being we have the lowest number of doctors and, on top of that, relatively speaking, an even lower number of consultants. Accessing the service, both mental health and acute hospitals, is coming back to the basic raw material.

How does one attract back consultants and doctors? The country made an absolutely fatal mistake ten years ago. It breached a contract blatantly such that the Minister of the day and the State offered contracts to 2,500 consultants, signed up to them and, within months, refused to honour them. I say it was blatant because I used to work in the Department of Finance in the early 1990s, after the depression at the time, and in the equivalent of the Department of Public Expenditure and Reform, DPER, we had a golden rule, which was one did not break contracts. Why? Once a contract with an employee or a group of employees is broken, they can no longer trust the person or body that broke the contract. We must remedy this breach in order that people can trust the State and, I stress, will honour the contracts they enter into.

The second thing we need to do, and it is an issue not just for the medical profession, but for teachers and nurses as well, is to end discrimination against newly employed professionals because equal work should have equal terms. These are very simple things, but unless we address them there will be problems.