Seán Crowe (Dublin South West, Sinn Fein) | Oireachtas source

The majority of people you talk to who are planning to emigrate, and it is the dream of most emigrants, think they will return home but that does not necessarily happen. People settle down and the quality of life can be better. It can be worse and they miss family and so on. The pandemic highlighted for many people the importance of being close to loved ones. It was very difficult for those in Australia to leave. There were all those challenges.

The most disturbing thing coming from the research was the reluctance to speak out because of the impact on careers and people being seen as troublesome and so on. The suggestion of the speak up guardian that Dr. Creese talked about is certainly something that needs to be looked at. However, it does not tie in with my understanding of those doctors and consultants who are in the system that they are people who are frightened and nervous about speaking out. The representatives were asked whether there was any evidence of impacts on career. The evidence is slim, if it is there at all, regarding that but it was said there is a culture in the system. That is something we can raise the powers that be that the committee deals with.

The fact that the representatives talked about low self-worth, not being listened to and not being asked about anything makes sense in the context of poor conditions. I was surprised about the pay conditions. We have heard from various representatives from different unions, including consultant groups and so on, and they all talk about the two-tier pay structure, which adds to the lack of self-worth. If a colleague earns more than someone who is doing the same job, that undermines self-worth. People before the committee a number of weeks ago talked about the impact that had on pensions. As people get older, they look at this two-tier system.

How would the representatives address the difficulties consultants are having with hospital management? What structure do consultants and doctors want? Would the guardian structure be enough? Is something else needed? It was clearly outlined that people need to be asked how they are getting on and so on, which is something that is lacking in the system. Is there anything else in the system or structures the witnesses are aware of that they can forward to the committee? We will try to use whatever knowledge we have of the system to push forward some of the issues raised.

We need data on doctors who have been trained, which was mentioned, and a tracking system for where they go and their career progression. That makes sense. That is something the committee could recommend.

The HR issue seems crazy. It appears to be something that would be easy to address. People are being underpaid, they are not paid being overtime, and there is the issue of emergency tax. If it is known someone is moving to a hospital in Munster, Ulster or wherever it is, those systems should be in place. There are possibly recommendations the committee can make in that regard.

Is there anything else the representatives believe is outstanding in the system? I am conscious that Dr. Creese has been taking part but has not been fully involved in the meeting. Is there anything more in the research that she would like to outline to the committee? I will then bring in Deputy Shortall. Deputy Durkan is also indicating he would like to contribute. Does Dr. Creese want to address any of the issues I raised?