Mr. Anthony Owens:

There can be no doubt that the Covid-19 pandemic has had a tremendous impact on our already overstretched front-line health service staff. In a recent survey that was carried out among the thousands of members of the IMO we sought to determine the exact impact. The three main impacts cited were preexisting staffing shortages exacerbated by Covid illnesses and requirements to self-isolate; the growing backlog of waiting patients; and the impact on doctors' personal health and wellbeing. However, we should be under no illusion, as these issues existed long before the pandemic struck. What is deplorable is that it is now almost one year since the first case of Covid-19 was diagnosed in Ireland, yet no substantial and systemic action has been taken to date to address the crises in recruitment and retention of medical expertise across our health system.

As a consequence, waiting lists have grown and stress and burnout are prevalent among the medical workforce. In an as yet unpublished IMO survey, 80% of doctors across all grades cited feelings of depression, anxiety and stress, particularly emotional stress.

Although public health medicine is the first line of defence we have against Covid-19, we have 60 public health specialists compared to 180 in Scotland and New Zealand where the population is of a similar size and is similarly dispersed. Public health specialists have the expertise and training to carry out risk assessments and manage and control outbreaks of infection in our healthcare settings and in the wider community and yet public health specialists have still not been provided with a consultant contract and the resources necessary to allow them to carry out their statutory duties. It beggars belief and should be a cause of considerable shame that these doctors, who are our front line in this battle, had to ballot for industrial action in the midst of a pandemic to have their long-running grievances considered in a serious fashion.

In the past year, hospital waiting lists have grown by approximately 70,000 or 9% and now stand at 838,000, yet the number of vacant consultant posts or posts filled on a temporary or non-substantive basis has risen to 730, more or less. The supply of medical specialists simply fails to meet demand. The HSE itself estimates that we require a minimum of 1,600 additional hospital consultants to meet the needs of our current population. If we include psychiatry and public health specialists, and we should, the shortfall is closer to 2,000. Still, however, no concrete measures have been taken to address the twotier pay structure among hospital consultants, which is the major factor contributing to the consultant recruitment and retention crisis.

There is no doubt that staffing shortages are impacting significantly on the mental health of our medical workforce and we have surveyed to establish that. Long working hours, excessive workloads, redeployment, requirements to cover for absent colleagues, the inability to get proper rest and take proper breaks and difficulties in accessing childcare are all contributing to high rates of stress and burnout among doctors. This is particularly evident among non-consultant hospital doctors, NCHDs, or doctors in training, who are seeing their training eroded by Covid-19. It is also the case among public health specialists where morale is at an all-time low.

General practice is not without its capacity issues. Some 600 GPs are due to retire over the next five years while the HSE's national doctors training and planning unit estimates that up to 1,660 additional GPs will be required by 2028. GPs are encountering difficulties in recruiting additional practice staff and accessing locum cover. Young GPs are finding it prohibitively expensive to establish themselves and build their own practices.

What can we do to address these matters? We must urgently strengthen public health medicine services through the immediate awarding of a consultant contract to specialists in public health medicine, as recommended by the Crowe Horwath report, the Scally report and the report of the Covid-19 nursing homes expert panel. We must ensure that adequate risk assessments are carried out across all healthcare settings. We must complete the vaccination of all front-line healthcare workers as a matter of absolute national priority. We must ensure that adequate supplies of quality personal protective equipment, PPE, for all front-line healthcare workers are available for hospital and community staff. We must encourage continued adherence to National Public Health Emergency Team, NPHET, guidelines through public education campaigns. All healthcare workers should have access to appropriately resourced and consultant-led occupational health services, including necessary mental health supports. In addition, all healthcare workers should be aware of their occupational rights and entitlements during this pandemic. This is not the time for fighting employers; this is the time to be on the same side.

We cannot hope to address the backlog of nonCovid patients on waiting lists, running at nearly 850,000, without addressing the recruitment and retention crisis as it affects hospital consultants. This is a longstanding issue that now requires an urgent solution. The Government needs to urgently address the twotier consultant pay issue. The HSE is not an employer of choice as the Public Service Pay Commission, among others, has found. Health service leaders know that to be the case and we suspect that many of our politicians also recognise that fact.

In the meantime, all higher specialist trainees, SpRs, who have finished training should be offered a temporary consultant locum post to get us through this crisis. We must also ensure a sufficient number of intern posts and training posts for those who wish to come into the service and contribute at this time. Once we get them in, it absolutely behoves the service to ensure that the working hours of our exhausted non-consultant hospital doctors comply with the European working time directive and the Organisation of Working Time Act. We know that they do not.

Finally, we need to provide additional support for established GPs to allow them to recruit the staff they will need. We also need to provide supports for newly establishing GPs to allow them to get through the difficult first few years.