Dr. Gabrielle Colleran:

The Deputy has made an important point. On 25 September, a conference took place in University College Cork, organised by Professor John Browne, director of the SPHeRE research and training programme, to discuss the recruitment challenges for smaller hospitals. Professor Frank Murray, formerly professor of gastroenterology at Beaumont Hospital and now director of the HSE's national doctors training and planning, NTTP, unit, gave a presentation on exactly the topic to which the Deputy referred. Things have not always been as they are now. In 2010, for instance, only 30% of non-consultant hospital doctors were in non-training posts. This year, for the first time, that cohort is at more than 50%. It is a very bad situation to be in because when trainees are in training posts, they are affiliated to a college and faculty, take examinations and have training days, and can access a range of supports that come with being affiliated to a training scheme.

Moreover, the distribution of these non-training posts is not equitable, with smaller hospitals affected to a greater extent than the larger hospitals. The same hospitals that have a high proportion of empty posts, locum consultants and non-specialist consultants also have the highest proportion of non-trainee NCHDs in post. This leads to inequitable access to care for patients and an unsupported experience for the doctors in those roles. In order for a post to be a training post, however, there must be a permanent consultant in post who is a trainer. We have ended up in a horrendous chicken and egg cycle where we do not have enough permanent consultants to be trainers and not enough training posts. As a consequence, there has been an explosion in the number of non-training NCHDs. We cannot fill our permanent consultant posts, we do not have enough training posts and the hospitals are left desperately trying to cover the service and provide the care. That has to change.