Professor Alan Irvine:

I thank the Chairman and members of the committee for the invitation to participate in this discussion. Ms Ní Sheaghda and Ms Clyne have eloquently pointed out that capacity is not just about beds, it is about people, including highly skilled professionals across all the medical and nursing disciplines that we need. It is clear that the health system lacks that capacity and has done for some time. The Irish Hospital Consultants Association, IHCA, represents 3,200 hospital consultants practising in acute hospital and mental health services, or approximately 95% of the total.

My remarks will mostly focus on the reasons consultant posts cannot be filled. Ms Clyne pointedly observed that these are not new reasons. They have been known and pointed out for many years. One of the greatest deficits is around listening. Some people will not listen, particularly to craft representatives. Too often, the offering from the employers' side is a one-size-fits-all, take it or leave it approach. If the employers' side were to listen carefully and implement what well-meaning and informed professionals from all of the groups represented here today were saying, we would not be in the current position.

As all present are aware, there is a severe shortage of hospital consultants. As Ms Clyne stated, there are 500 unfulfilled posts. Government reports itself have outlined an additional 2.000 posts are needed. The result of that shortage is very damaging for patients. Waiting lists for hospital care have ballooned in recent years, particularly since the 2012 decision. I entirely agree with Ms Clyne that that decision was politically motivated and exceptionally damaging. If the committee wishes to know why there are not enough consultants, it is as a result of policy decisions that were not evidence based or done in a collaborative way but, rather, imposed unilaterally. The decisions were foolish, absolutely counter-productive and costly. On every level, it was a gross error. What worries me is that the errors and political thinking that led to that decision persists and we will probably not fix the problem unless we change the culture and thinking around how we fill those vacancies.

The number of outpatients waiting more than 12 months is a record 250,000. There are 1 million people waiting for care in the public health service, including approximately 840,000 on lists and 190,000 waiting for diagnostics such as CTs and MRIs. More than 17,000 people are waiting more than a year for inpatient or day cases, compared with 131 awaiting such treatment in 2012 when the decisions to which I referred were made.

We have gone from 131 people waiting for over a year to 17,000. It directly ties in with a really ill-advised policy decision. One can see a clear cause and effect.

We have also had to recruit doctors who are not on the Medical Register. There are 117 of these in the HSE by the last count. That has been the result of adverse commentary in the High Court by Mr. Justice Peter Kelly and others.

What does it look like around the country? We see in Cork that approximately 35% of acute trauma cannot be listed in orthopaedics because the hospital does not have consultants to do it. In Cork and Kerry, there are the same number of ophthalmologists as there were in the late 1970s. We are all aware of the issues there with regard to people having cataract surgery. There are examples of this all around the country. The single most significant determining factor is the decisions made in 2012, which have not been corrected and continue to perpetuate these issues.

As Ms Clyne said, and we completely agree, we have the lowest number of consultants in nearly every discipline in Europe. That is a false dichotomy.

I want to specifically address our younger consultants, who are being discriminated against, as we have heard. They carried an extremely heavy burden of work in the past seven months and will have to do that in future. These are colleagues who we value greatly, and we, the health service and our people need more of them. We need to treat them properly and encourage them to work in the health service. That includes trainees in training schemes and higher specialist training, who want to be encouraged to come back. I echo Ms Clyne's point on that.

We are borrowing much money and expanding the health service at pace. We need the right people and we need to get them in rapidly and on terms they are happy to work on. We need to see clarity about how many consultant posts will be funded and how they will be filled in a short period. Some 16,000 additional staff are coming. The committee has heard from my colleagues about how difficult it might be to fill positions in their disciplines and we agree. It is the same for us.

To summarise, given the persistent shortfall of 500 posts, a clear conclusion is that the current offering is simply inadequate, in a broad sense. That applies to all of the pay and conditions, including the flexibility that is needed to bring people in. At this stage, most employers and organisations would conclude that maybe they need to engage with the people who are likely to fill these posts and improve their offering. We will start with a blank sheet now. I have been a consultant for 18 years. This has not been the way things have been done or how business has been conducted, and that is why we now have a health service that does not have adequate capacity for our people. We need to dramatically change the way that we recruit people. There needs to be much more listening, action and implementation, to echo Ms Clyne's comments.

There is no time to lose. Winter is coming. We need to build for this winter and every future winter. I will conclude my remarks there and, like the others, I would welcome and be happy to address questions.