Ms Susan Clyne:

I will speak on the public health consultant issue. The Deputy is correct about public health doctors. People were very unaware of public health and all of a sudden the whole nation has become public health experts. In 2003, around the time of SARS, public health specialists had to resort to industrial action. We have 60, and it is a mainly female workforce, who are not consultants yet are expected to lead teams to deliver the care. Recently we had a meeting with our public health members. They unanimously decided that if the Department and the HSE did not progress this matter they would have no option but to take industrial action. The Department and the HSE have both confirmed that they would address it, and the Minister confirmed that to the Covid committee. However, we have not yet had an invitation to the Department for any serious talks. These people are absolutely on their knees with exhaustion. Most work seven hours a day, have little or no cover, and have very few support staff. Both the winter plan and the budget anticipate that support staff will be hired in but there is no definitive commitment to award consultant contracts to the 60 people who are already there and at least increase the numbers to 85 immediately, increasing it to a similar level as Scotland or New Zealand over time. These public health doctors, no more than other consultants, are like gold dust - every health system wants them. Our people are being recruited into the UK, particularly Wales and Scotland, where they are told they can work for the NHS but do so from Dublin. They will not have to leave Ireland while they work for another jurisdiction. It is so galling for them. They are managing all the outbreaks in every residential centre, in schools, in work places and they have to train up the contact tracing teams. We have seen the problems that have arisen with contact tracing over the weekend. There are just too few of these positions and way too much is being asked of them. There is absolutely zero respect being shown to them. Politicians, and many others, are busy thanking public health doctors, congratulating them on all their efforts, yet they are having no meaningful engagement with them to sort out this contractual issue which has been very long standing. Furthermore, there are not enough trainees. Career prospects for this specialty are so poor that there are not enough trainees in the system to match the numbers retiring out of the system.