Professor David Keegan:

I went abroad in 1997. A consultant was appointed the following year and was the first new appointment in Dublin in ten years. That vista has changed dramatically so we are in a better place than we were in 1997. There is no doubt about that. We do not have a lot of involuntarily exiled ophthalmologists abroad. There are more posts but, again, you must look at the choices regarding these trainees. We have a very good training system here. They then go to the US, UK or Australia for further fellowship training so they are very well-trained. We must then look at what we are bringing them back into. It is a broader discussion than this morning's discussion. We need to look not just at the working environment but at whether they can advance initiatives such as those we are discussing here where we carry out really innovative care or innovations in a laboratory or research. There is a large package. We will often talk about what a consultant does. A consultant is a clinician, a teacher, an academic, an advocate and a manager. A consultant is all of those things. People want to do all of those things and there are various levels. Some of my colleagues accuse me of just being an administrator these days, but I prefer being a surgeon.

It is important that the right infrastructure is there to bring people back. Very often people are looking for clarity. One of our trainees is in Birmingham, which is a real centre of excellence for neuro-ophthalmology. It is niche but it is a vital need and we need more neuro-ophthalmologists. Already this trainees has ideas about what should come back in. Another colleague who is just back in a locum position trained in the National Hospital for Neurology and Neurosurgery in Queen's Square in London. We should encourage them to come back but we need to make sure that when they do, they come back into a position they want to go into and stay in because then they will deliver the care the public needs.

We make sure that when they come back to Ireland, it is into a post they want to go into and want to stay in, because then they will deliver the care the public needs. One of my catchphrases for many years, if I am allowed, has been that our job is patient care followed by sustainability of the profession, which is future patient care, and everything else outside of that is a vested interested. That is sort of the principle we are trying to advocate in and around this particular plan and across the country. There are, therefore, many facets to it. It is not a simple fix. We will stumble along the way, but I would rather stumble with this team than any other. We regroup and we go again.