Ms Susan Clyne:

The Irish Medical Organisation, IMO, represents almost 7,000 medical professionals working across the acute primary care community and public health settings. Dr. Sadlier and I thank the committee for the invitation to speak on medical workforce planning, but we draw its attention to the fact that one year ago, we presented to the then health committee on this topic. It is a matter of extreme regret that little or nothing has changed since then. In fact, the situation has worsened despite numerous reports pointing to the chronic shortage of doctors.

Covid does not only expose the fragility of the health service in terms of its infrastructure and bed capacity. In addition, we are facing the enormous challenge of asking an understaffed and exhausted to deliver Covid and non-Covid care. It is evident that post Covid we will continue to have too few doctors to meet the health demands of an increasing population unless we act now.

The current picture is one of shortages across the system. There are 500 vacant consultant posts, leading to growing waiting lists - there are now more than 840,000 people on a waiting list. That leads to delayed diagnosis and treatment for patients which, in turn, leads to increased mortality. Ireland has the lowest number of specialists per head of population and not a single specialty has the required number working in it.

The HSE national doctors training and planning unit suggests that the HSE has a deficit of 1,600 hospital consultants. If one includes psychiatry, that deficit rises to approximately 2,000 consultants. Each year, slightly more than 700 doctors enter basic specialist training, while approximately 500 doctors enter higher specialist training. The HSE estimates that a minimum of 648 additional training posts are needed just to cover hospital-based specialties. That does not include general practitioner, GP, training places.

The healthcare system relies on a large number of doctors from non-EU or EEA countries who, up to now, have had no access to training posts. Although legislation has been passed to enable such access, all that is doing is increasing the number of doctors competing for a static number of training posts, which does not improve the manpower situation. A minimum of 600 GPs will retire in the coming years. The HSE estimates that we need an additional 1,260 GPs in the coming years to ensure we can meet the demands of patients. It is imperative that up to 350 GP training posts per year are funded to meet future needs.

Incredibly, there are only 60 public health medical specialists. The Crowe Horwath report which was accepted by the Government recommends increasing that number and ensuring they are supported by multidisciplinary teams. By comparison, New Zealand and Scotland, which have roughly the same population as Ireland, have 180 public health consultants. Worryingly, 50% of our public health medical specialists are due to retire in the next five years and there are insufficient trainees in the system to match those retirements, let alone to cope with any expansion of the workforce.

We have seen increasingly high rates of emigration by doctors in recent years and can state with some degree of certainty that that trend will continue. Doctors leave to enhance their skills and receive additional training but, unfortunately, they are not returning to Ireland. Doctors wish to work in a system that enables them to deliver care to patients and in which they are respected. For many, that now means going abroad.

For some years, the IMO and other organisations have been highlighting these issues. Successive Governments have commissioned and produced reports, all of which support the need to plan and resource medical manpower. What has been lacking is implementation, investment and resources. At a minimum, there is a need to resolve the disastrous two-tier pay system for consultants. It is inequitable and unfair and has been the biggest barrier to recruitment this country has ever seen. This politically motivated pay cut has had a very damaging and dangerous impact on the health services. Although we welcome the commitment to hire an additional 300 consultants in 2021, it does not even address the current 500 vacancies. There needs to be far more ambition in terms of recruitment targets to support the clinical programmes and models of care.

Public health specialists must be awarded consultant contracts. It is particularly galling in the context of Covid that the very doctors on whom we are relying to manage the pandemic are not recognised for their skills and expertise. We must significantly and rapidly increase the number of training posts across the specialties and ensure that training programmes lead to clear career pathways for trainees. Far more account must be taken of the needs of trainees and the changing demographic of those coming into medicine. In general practice, the transfer of care from acute settings to the community must be properly supported. It is very difficult to manage unplanned care and GPs are suffering from the same capacity issues as the hospital sector. In light of the demographics of the GP base, who are an older population, supports for GPs who wish to establish in general practice must be delivered.

I ask the committee to note that we have all the recommendations we need in terms of planning for our future needs but what we lack is investment and funding. This situation is bad for doctors but, more importantly, it is disastrous for patients and health outcomes. Dr. Sadlier and I are happy to take any questions.