Professor Frank Murray:

In terms of medical training in mental health, to meet legislative obligations the HSE has established formal, structured contractual arrangements with any organisation that provides medical education and training. These arrangements have been formally incorporated through service level agreements between the HSE and training bodies. For mental health, the service level agreement is with the College of Psychiatrists of Ireland, which is the formal recognised training that is credited by the Medical Council.

It is important that I outline how postgraduate training, which takes place after an intern year, is structured. Traditionally, postgraduate specialist training is delivered in a two-stage process. First, there is basic or initial specialist training. Members will know it as senior house officers or SHOs, which is a term that we still use today. Second, there is higher specialist training, which is known as specialist registrars. In recent years there have been significant changes in the delivery of postgraduate training in Ireland. Many training programmes have transitioned towards a model of streamlined or continual training so that people move directly from initial specialist training to higher specialist training. The next paragraph of my presentation is on streamlined training, which I shall take as read.

It is worth reflecting on doctors in training in mental health. In 2017, as many as 233 trainees undertook initial specialist training in psychiatry and 104 undertook higher specialist training in psychiatry. That means there are 337 doctors in total training to be specialists in psychiatry. They are divided into two streams. Child and adolescent psychiatry has 20% of the trainees and adult psychiatry has 80% of the trainees. I have outlined the numbers in my presentation. I have also provided some charts showing data. Figure 1 shows the number of trainees per year in initial specialist training over the past several years.

On page 4, tabular statement No. 2 shows data about consultants. One can see the following: 104 doctors work in child and adolescent psychiatry; 259 doctors work in adult psychiatry; 43 doctors work in the sector called the psychiatry of learning disability; and 52 doctors work in the sector called the psychiatry of old age. The total is 458 consultants and we have half the number of trainees as we have consultants in psychiatry.

Figure 3 shows the age profile in psychiatry. Between a quarter and a third of consultants are more than 55 years of age, indicating problems for the future in terms of retirements.

Figure 4 shows a topic that has been discussed a considerable amount in recent weeks, namely, the number of psychiatry consultants not on the specialist register. This figure shows that, depending on the subspecialty, between 4% and 9% of doctors working in psychiatry are not on that register. In other words, they do not have a certificate of completion of training.

Members will note from figure 5 on the number of doctors in psychiatry that, depending on the subspecialty, between 13% and 22% of consultant psychiatrists hold non-permanent contracts of one sort or another.

Figure 6 shows the geographical distribution of psychiatric consultant posts by healthcare setting.

These tables show more or less the first half of what I want to address in an abbreviated form, that being, the role of the HSE's national doctors training and planning, NDTP, with a particular emphasis on psychiatry. I am happy to take questions on this or to proceed to the second part, as the committee wishes.