Dr. Peadar Gilligan:

As to the first question from Deputy Naughton, absolutely staffing levels are a huge issue for us, and the loss of acute hospital capacity, specifically in-patient beds in the acute capacity, has been a huge issue. We certainly have seen a worsening of crowding situations and the further prolonging of waiting lists in the context of the loss of capacity. To me, if one were to think in terms of setting up a study to assess the impact of reducing capacity and staffing in the health service, we have done it and we know that it impacts directly on patient care. It creates delays in emergency departments for patients requiring hospital beds. It creates elongation of waiting lists.

With regard to Deputy Naughton's specific question, we absolutely agree that there is a requirement for an increase in acute hospital bed capacity. This needs to be informed by a bed review looking at our population demographic and the potential changes in this over the next ten years. We know that as we are currently we are not able to service the health care needs of our population who require hospitalisation in a timely and safe manner. We absolutely must address capacity. I thank the Deputy for the question.

With regard to Deputy Kelly's questions, I will leave the salaried GP component to Dr. McGarry if I may. On the issue of consultants and public-only salaries, this was addressed in the 2008 contract. Sadly, it is that group of consultants who work only in the public hospital system who have been most affected by the cuts under the public sector agreements and by the 30% cut that was imposed. We are now faced with a situation whereby more than 250 consultant posts have been left vacant. We have more resignations from consultant positions than ever before in the history of the State. This is largely because doctors feel they are not being adequately resourced in the delivery of services. They do not feel they that the necessary staff are being made available to them and surgeons are of the view that they do not have the necessary time in theatre.

While it was identified within the 2008 contract that there was a role for an entire commitment to the public system, that part has suffered most as a result of public sector cuts. We must also be cognisant of the fact that there is a 2008 contract for consultants that has never been honoured by the employer. That has had a dramatic impact on recruitment and retention. A 30% pay cut to all new consultants had the most devastating effect on our ability to recruit and retain because suddenly we were saying to doctors we wanted them to take on all the responsibilities of being consultants, and they are considerable, to delineate them in the form of a contract but we would not honour that contract when it came to the terms and conditions they could expect, and all new entrants would be paid 30% less. It makes no sense at all and until it is addressed and fully reversed, we will not be able to recruit and retain consultants within the Irish health system to provide the level of care that we know we can and want to provide.

In response to the question on the requirement for independence of a commission examining our mental health services, it is very important to have that independence because there are so many things that need to be examined and there is a significant requirement for the resources in that area. Suicide is a huge problem for our population and has devastating consequences for the families and friends of the individuals who commit suicide. We need to be in a position to prevent that to the greatest extent possible. Our current system is under-resourced to allow that happen.