Mr. Andrew Condon:

Deputy Buckley raised a related point earlier. In recruitment, one might say we should know at the start of the year what posts are funded since we have a national service plan. That is one source of posts. Another source is when people retire or leave and they have replacements. A third source is during the course of an average year in the health service, we will get additional funding for various purposes which will generate additional posts. We have posts coming from three directions, two of which we can anticipate and one of which we cannot.

In terms of retirements, NDTP already notifies hospitals of retirement dates of consultants, for example that Dr. Smith is retiring next year or in two years' time, and asks the hospital where the application is for his or her replacement. That controls the anticipated retirements to a certain degree. When people take up posts we know their retirement dates and we deal with that. What we cannot plan for is the unanticipated retirements. The other issue that arises with retirement is that while the average duration of a consultant career is 25 to 30 years, the post that was approved 25 or 30 years ago may not be the post that is needed today. When someone retires, it is not a simple matter of rolling over and getting an identikit replacement. It often sparks a local debate around the structure of the post and its nature. To go outside psychiatry, we might have a consultant respiratory physician that people want to replace with a gastroenterologist. It is not as simple a process as it might be.

It is important to remember that we have new posts, service plan posts and replacement posts, some of which we can plan for and some of which we cannot. In terms of the issues Professor Murray has mentioned regarding the posts under discussion today, the core of our recruitment issues is supply. Are the trainees there? In the case of the work of the Public Appointments Service that I discussed with Deputy Neville, we found the supply did not exist internationally. We could approve posts but we were simply creating vacancies because the candidates were not there to fill them.

The second issue that arises is location and the resources and configuration of the service. That is connected to the implementation of A Vision for Change, the multidisciplinary team and so on. The third issue is terms and conditions. Do we pay people enough? Are their contracts structured correctly? In the last years we have had our end-to-end review of the recruitment process, the Keane report. Professor Murray has started his work and we have also had industrial relations engagement with the two medical unions. We are currently engaged with the Public Service Pay Commission on the terms and conditions for consultants. One of the things we have flagged in our submission to the commission is that psychiatry is the number one recruitment challenge for consultant and medical posts in the HSE. That submission has gone in and some of the issues the Deputy has raised have been flagged in it.