Mr. Martin Varley:

I thank Deputy Durkan. We touched on some of these issues during our last exchange with the committee and I thank the Deputy for raising them again.

The reduction imposed on new entrant consultants in 2012 was an additional 30% on top of the 10% for new entrants. It has never saved money, for reasons I can point to. We have longer and longer waiting lists. We are outsourcing more than an extra €100 million next year. Our agency bill has gone up to €90 million. That is the medical agency only, which is an increase of more than €60 million. Our cost of indemnity has quadrupled, and I only quote the cost of clinical indemnity that the State Claims Agency is responsible for. If one compares this internationally, our costs of indemnity are much higher than any other jurisdiction. There are a variety of reasons for this. I am quite sure that our low staffing is a contributory factor. A recent Medical Council report on training counts found that where trainees were working long hours - as often happens with a 50 or 60 hour week - there is quite a high incidence of being involved directly or indirectly in an adverse incident concerning a patient.

There is a correlation which the statisticians will see if they wish to go and do the work. It is common sense that understaffed teams will lead to more clinical indemnity problems and that longer waiting lists will cause more adverse outcomes for patients. We are dysfunctional in how we are managing the health service, not in how we are delivering it. There are excellent staff on the front line who are doing their absolute best in extremely difficult circumstances. The decision by Dr. James Reilly was not justified at the time and no other group of public servants was singled out for such a cut. There was a related but not equivalent cut for the Judiciary, but it was reversed in full earlier this year. One group of public servants has been left with a salary differential of between 30% and 40% and it is the one with the biggest recruitment and retention problems. We want to engage with the Minister and have been seeking a meeting with him for the past seven months. Making progress involves engagement. When officials and the Minister do not sit down and engage with the body which represents 95% of consultants, we know that there is a problem. The problem is not with the consultants who are seeking the meeting but with those who are not engaging.

The amount of money required to run an efficient and effective health service is multifactorial and we do not have the manpower to analyse it. We spend €1.23 billion less in Government funding on public hospitals than the EU average and have the lowest numbers of beds and consultants, with the highest bed occupancy. In running any service such indicators would be used as guidelines in progressing and solving the problem. We need to redirect funding to the front line to deliver care, meaning that acute hospitals and mental health services have to be funded appropriately. The mental health service is very poorly funded by international comparisons, as are acute hospitals. We want to sit around the table and work through these issues, but we are not in a position to tell anybody what the health service requires by way of funding for the future, as thousands of public servants are paid to do that job. I was a public servant once, but I do not have to do it any more as I am preoccupied with a far wider brief. I hope the public servants to whom I refer are prepared to meet us to brainstorm on the issues and come up with solutions.