Dr. Gabrielle Colleran:

I am happy to address the consultant question. It comes down to capacity and is about having enough beds and staff. We have the lowest number of specialists in Europe, with 728 unfilled posts and significant unmet need. We are asking for there to be enough colleagues for management workloads and safe call rosters, that is, just the basics so that we can do our jobs. As for the infrastructure, what we have seen in terms of nosocomial infections is that our hospitals are just not fit for modern infection control, so we need rapidly to replace many of the acute beds in our system with single-room hospitals, that is, modern hospitals for modern infection control. We know from history that it takes too long to provide public beds in the Irish system. It takes seven to eight years, while it is turned around much faster in the private sector. Some of that is tied up with tendering and processes. We have a great deal of public land and we need to get new beds into the system that are built for modern infection control.

The 30% pay cut is the big barrier; we know that from talking to consultants who are on fellowship abroad. Fairness is important in every aspect of life. If two people are being treated differently and one is being paid 30% more than the other, it is not a recruitment and retention strategy. That is the biggest barrier. If that is addressed and more staff come in, people will be able to get through the work. I cannot describe to the committee what it is like when one sees the impact on a child or adult who has been waiting so long on a list that he or she has a worse outcome. There is a moral injury with that and it damages doctors, nurses and health professionals. We need to remove it from our systems because when trainees who grow up in the system go away to Australia, New Zealand or America, as I did, and they work in systems where they can consistently feel proud and they do not have that moral injury and damage, they do not want to feel it again. That is part of why they stay away. If we fix the system so that it works for patients, and if we have capacity to meet need, that is when we will attract and retain people because of that feeling of being part of something excellent.

In many pockets of our health service, people are very satisfied with the care when they get in because we have excellent teams. We saw that in the way that our healthcare workers responded to this crisis and stepped up, but too many people wait too long for access to scheduled care. "Elective" care makes it sound as if it is not urgent, but if an elderly person cannot walk to the shops or to mass because he or she has hip pain, or if he or she cannot drive because he or she has not had a cataract operation, that elective care is essential. We have to get the capacity into our system. The belief that, somehow, our public health system cannot be fixed has to be tackled.

While I have this opportunity, I must talk about psychiatry. There is a critical lack of beds in the psychiatric system. When psychiatric consultants are on call, they do not have beds even for people who are suicidal. They ring around trying to beg and borrow beds for people who acutely need admission with suicidal ideation or psychotic episodes. We are discriminating against psychiatric patients and people with mental health issues. We allocate 6% of the total health budget to mental health, whereas it is 12% in the UK and it still has issues. There is an urgent need for parity of esteem for mental health in this country. We are letting down a generation of Irish people. We are seeing the impact of the pandemic on our children. There has been an increase in the number of presentations with mental health issues to our paediatric emergency departments. We really have to address this issue.

When I look to the trainees coming behind me, I want to fix the system so that they see a future leading and innovating in it and so that they will want to stay in the system. As soon as the world opens back up, we will see an exodus because of the trauma of what has happened during this pandemic to our trainees and because of what they are seeing in terms of how our healthcare workers are being treated. As Ms Ní Sheaghdha so eloquently articulated, we were abandoned when the schools were closed, with no plan for us. In Northern Ireland and Britain, children of healthcare workers are going to school, whereas my children and my colleagues' children are being traumatised. They are falling behind and we are too tired and burned out to help them with homeschooling when we get home. I got home at 9.15 p.m. on Monday last and my seven-year-old was sitting there with her Abair Liomon the table, waiting to do her Irish homework with me.

I burst into tears. I had nothing left to give. She is stressed because she is falling behind. The anxiety is through the roof. We are not working from home, so we are not there to support our children. We feel we have been abandoned by the State at exactly the time when we have all stepped up. We went into work every day before we were vaccinated, putting our own lives on the line, seeing colleagues getting sick, seeing colleagues being out with long Covid and not coming back, knowing that we were at risk of that ourselves, but there was no plan for us. The schools just shut and there was nothing to help us, but it was our problem and our cost to absorb.