Professor Frank Murray:

In terms of the unfilled posts and the 20% non-permanent staff, there are critical issues in recruitment and retention of consultants in all specialties. It is particularly marked in psychiatry. As the Senator identified herself, some of those posts are in the more rural settings.

That is a problem in Ireland and everywhere. It is much more difficult in most jurisdictions to recruit consultants to non-urban centres for a whole variety of reasons. Partly it is to do with people making lifestyle choices. It is also partly to do with the fact that when one is working in a smaller setting, for instance, it can be much more challenging. When one is working in a setting with more colleagues, one has a greater range of expertise and sense of working in a team which makes work a lot less stressful. These are almost existential questions. They are worse in psychiatry and mental health services than they are in other specialties. If one looks at consultant posts with no or one applicant, psychiatry is, unfortunately, a leading specialty in that regard.

What are the alternatives in these circumstances? My own long-term view is that psychiatry being doctor-led is probably the right way to go. In some settings which are remote and more difficult to staff, however, we need to be more creative. If one looks at Canada, for instance, where remoteness is on a different order of magnitude to here, it has some differences in how it recruits and retains medical staff and other staff. We possibly could learn from Canada as well. However, I would argue that what we judge as remote is not really remote by Canadian standards. Canadians talk about two-hour plane trips in terms of being remote.