Dr. Gabrielle Colleran:

The Deputy's point relates to the definition of a consultant, which is a specialist consultant on the specialist register who is capable of independent practice. The Deputy asked whether we were aware of a method of supervision for those who were practising as consultants but were not on the specialist register. No, we are not.

My parents-in-law are from Kerry. If they go to their local hospital and see someone with a consultant badge, I expect that that person is, by definition, on the specialist register. What being on the specialist register means is that someone has gone through the appropriate training scheme and passed the relevant examinations. There is a minimum standard that he or she has met. If someone is not on the specialist register but is on the general register, the minimum it means is that he or she has passed an internship. However, there can be a large discrepancy in what examinations they have passed and what experience they have. For the public, it is false advertising if someone has a consultant badge and is not actually qualified in that way. Speaking as someone with family outside Dublin, my concern is that the numbers are not spread evenly across our acute hospitals and are mainly concentrated in pockets. I will not name the hospitals, but committee members could probably guess them. It is a concern that there are pockets where there is a lack of permanent consultants, locums and non-specialist consultants who are not on the specialist register are in place, and the majority of NCHDs are not in training posts. That is not the desired mix for a high-quality and safe service for patients. Everyone in Ireland deserves timely access to a high-quality service. We have to do better than this.

To be fair to the hospitals in question, they are desperately trying to provide the medical care that is needed. When they do not have the qualified staff, they are faced with a choice between whether it is riskier not to provide any care or to have the care provided by someone who is not fully qualified to provide it independently. I do not know of research in other countries into this question, as other countries do not do this.