Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thank all of the delegates for coming. I will start with a number of questions about the hospital consultant issue, even though many others have also contributed on it.

My concern is that ten years on from the recession, we are not making inroads in recruitment. Sláintecare, on which many members of the committee worked a number of years ago, is a roadmap for a period of ten years, but it will not be doable if we do not have the necessary front-line staff. For example, Beaumont Hospital recently lost three dermatologists to the private sector. It now has only one whole-time equivalent in dermatology and 400 patients have been referred for dermatological treatments in the private sector or elsewhere. Here we are again, with consultants being poached by the private sector. In the Bons Secours Hospital in Cork the last 12 appointments have been made from Cork University Hospital. There is a huge amount of leeching. An emergency department consultant left Tallaght Hospital recently to enter the private sector. I understand the argument about the market and consultants, but when one looks at the sub-specialties where there is very little private work such as emergency medicine, psychiatry and paediatric radiology, these are areas in which we have some of the most acute recruitment problems. We continue to recruit administrative staff, as Senator Colm Burke pointed out, but we are losing front-line staff such as nurses, consultants and the people we need to do the work on the front line. I know from talking to hospital consultants that they are very disheartened.

Reference has been made to the IMO letter, but we must consider the issue of false economies and locum staff. A locum anaesthetist in Bantry was paid €415,000 to do a job last year which is far in excess of the salary of a permanent consultant. Tet locum consultant had no role in education, training or any of the other work in which permanent consultants engaged. To my mind, the total cost to the health service is almost €600,000, which is not sustainable. There are 108 consultants who are not on the specialist register, SpR. As members know, they are concentrated in regional hospitals, which is a huge risk. While I did consider naming the hospitals in question, I decided that it would not be fair to the representatives who are here. There is a figure of €3 billion in State Claims Agency costs, 90% of which comprises health claims. We are training the most doctors, exporting the most and then poaching them from developing countries which is in breach of WHO guidelines. Despite plans, including implementation plans, and so forth, I am very concerned that we will end up in a situation where we will not have the expertise required. There was an acceptance a number of years ago that the country was on its knees and that we would have to put our shoulders to the wheel.

Many consultants are running out of patience. I am concerned that we are dumbing down our health service and dumbing down quality. It may get to the point of no return and we may never be able to implement Sláintecare. Perhaps the Minister or an official can tell me how many consultant posts around the country are unfilled. What is being spent on locums and temporary staff?

Another massive issue is the annually increasing spend on the National Treatment Purchase Fund. This obviously has its benefits in that people get treated, but it is not a sustainable model of care for treating patients in the system. It was always expected to be a sticking plaster for areas in which there were capacity issues rather than an attempt to stop a haemorrhage. It was not supposed to export our patients.

The consultants claim that €20 million per year will attract consultants home. They claim they will not work on the same corridor as someone who earns more than them for doing the same job. It seems very reasonable. I agree with the Minister that it is about far more than pay, but it must start with pay parity. Something has to be done and some way forward has to be found. These people are not just doctors, they are the people who are running the system and who have corporate knowledge of the Irish system. If we lose the goodwill of the consultants, we will never be able to implement Sláintecare.