Colm Burke (Fine Gael)
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I thank the witnesses for attending. It is a very difficult task to organise the entire hospital structure and ensure there is an adequate number of doctors. Let me refer briefly to structured training. On the last occasion on which we had a quarterly meeting, I asked for a breakdown of the number of doctors on six-month contracts, 12-month contracts, two-year contracts and three-year contracts but I could not get an answer. If 80% are on structured training, what is the nature of that training? Is it still a case of six-month or 12-month contracts?

I accept that, with the reconfiguration and restructuring of hospital groups, we will be better off and able to do very much what is being done in the United Kingdom, where one might get a three-year contract, albeit a contract that might cover three or four hospitals. I fully understand that.

With regard to the doctors we brought in from Pakistan and India in 2011, I understand there are more than 230. I understand these doctors will not be offered unemployment once their two-year contracts end. I have been told about a case in a particular hospital where there are five or six registrars in anaesthetics. One is an agency doctor, rather than a locum, and is therefore being paid at the top rate. Although the doctor was offered a six-month contract, he would not take it because he came in under an agency. A doctor from Pakistan on a two-year contract would be suited to taking up the registrar post but if one applies the rules the witnesses are talking about applying, that doctor cannot be offered the post. The hospital has had difficulty filling posts in this particular area. What do we do in the circumstances? Do we still continue to pay double for the agency doctor as opposed to offering a job to someone who is, in the hospital's eyes, competent and who has two years' experience?

The next issue I wish to raise in regard to recruitment from Pakistan is mentioned in the report. I am a little concerned about it. On the last occasion, under the supervised division people had to sit exams. Under the new arrangement – this pertains to my question on doctors who have two years' experience – it is proposed to bring in people who will not be required to sit an exam before they start. I am open to correction but need clarification on it. Furthermore, the candidates will have no experience of having worked outside their own countries. Therefore, we are starting an entirely new process. Are we losing out as a consequence?

The final issue I wish to raise is the major concern of a number of hospitals, smaller ones in particular. In the past, they were able to carry out their own recruitment, and they were able to do so very well. They did not have a problem because they were taking recommendations from colleagues and were able take on doctors to fill the vacancies as they arose. Under the central recruitment system, the small hospitals find they are not necessarily getting doctors of the standard that they used to get. The knock-on effect is that, where consultants are on a one-in-two or one-in-three rota, nursing staff lose confidence. This is because the junior doctors are under a lot of pressure and are tired. Nurses are contacting the consultants on the one-in-two and one-in three rotas and it is now proving very difficult to provide a safe system in the hospitals both in regard to junior doctors and those at consultant level. While centralised recruitment is great in theory, has there been consultation with the smaller hospitals to try to surmount the difficulties they must deal with the present?

In obstetrics and gynaecology in Cavan, there are five registrar posts but only two are filled. Consequently, there are three vacancies. There is a problem in Limerick with regard to filling vacancies, and Tralee also has a problem. This was mentioned in the report. Could this be clarified?