Dr. Gabrielle Colleran:

Many of us have come back from abroad. Dr. Durcan likes to say Irish people are like salmon in the sense that they want to come home. Irish people are very passionate about their healthcare system and really want to contribute to it. The reality is that when one goes away to work in different systems that are properly staffed and have the capacity needed, it is very hard to come back to work in a system that does not work for patients. I will explain what I mean by referring to the concept of moral injury which comes from the military. It means that doctors tend to move into healthcare because they care about people, want to help patients and improve things. When an endocrinologist like Dr. Dennedy is working in our system, he deals with patients who have to wait 12 or 18 months to access the CT or other scans that determine the next forms of treatment they need. In such circumstances, the greatest impact is on the patient. It is hugely damaging for them and their lived experience. For the doctor who wants to help and improve things, there is a moral injury that occurs day in, day out when he or she is working in such conditions.

We have heard about the culture in the medical sector and the bullying that happens. There is a very high level of burnout among doctors in our system. When people start to burn out, the first thing that starts to happen is dehumanisation. Doctors start to lose their empathy for others because they are so overstretched. Our consultants have huge workloads. Staffing levels are at half of the European average. Consultants have to run around to cover the gaps. They try to protect patients from risk. They try to pick out the person among all of those who have been on the waiting list for 18 months who has a hidden cancer or a degenerative neurological condition that needs earlier intervention. They have to manage significant levels of risk. There are substantial levels of burnout and moral injury as a result of being unable to provide care.

Any time I treated a child in Boston who needed an MRI scan, I was able to ask his or her parents whether an appointment that evening or on the following Saturday would be best for them from a employment point of view. I was able to ask parents what worked best for them. As a doctor, there is great satisfaction in being able to provide care when people need it in a way that is responsive to their needs. Doctors in our system do not experience this because of the lack of capacity. No amount of resilience training or packages will help. We need to staff our teams. I appreciate that pay parity, pay equality and equal pay for equal work are some of the basic things in which Deputy O'Reilly's party believes. For us, it is a basic part of safe staffing and making the workplace attractive. Proportionately, we train the highest number of doctors in Europe. Our doctors are of a really high quality and can go anywhere. They are loved in the New Zealand and Australian medical systems.