Dr. John Hillery:

The agency issue is particularly close to our hearts because it has a few effects. First of all, there is the risk to the public because of non-specialists. Dr. Plunkett's point is really valid. The public is going into a service that has no continuity and that has "leaders" who are not in leadership roles because they are temporary. I had an excellent higher specialist trainee a few years ago. In line with the Medical Practitioners Act, I went to offer a second opinion at a Dublin hospital. I was not happy with the notes I had seen so I went back and asked the trainee about it. She told me that the consultant in question was her senior house officer before she came to work for me but the person got the membership and then applied for a consultant post rather than applied for training because the money for the temporary consultant post was good. So it has two effects. It is taking certain people away from training because they see that this is better paid but it also means that the trainees, who are experienced, qualified and write papers - my trainee at the time was finishing her MD - are answerable to somebody with fewer qualifications and experience. This cannot be good for the public. Part of the reason for the agencies seems to be a historical issue that goes back to when I was a junior doctor, which is a few years ago now. When someone is due to retire, we know when they will do so. People usually retire on their 65th birthday. It is after this that everything kicks into place so there is a mad rush to look for someone to fill the post. Sometimes they ask the person who has been doing it to stay on. Many of us do not want to do that anymore so they look for someone else. A process then arises for the creation of a consultant post that, as I have outlined, can take a few years while in the mean time, roles are filled by locums and the higher trainees who we have trained are looking around and saying that no post has been advertised for which they have been trained but there is one in Australia, the UK or somewhere else or in the private sector and they may as well try that. We just do not seem to be able to get that act together. It has been going on for as long as I remember and it is very damaging. The most significant point is that it puts the public at risk.