Dr. Roisín Plunkett:

That is a really great point. If the committee is getting the NDTP in to talk, it will talk about the MacCraith report. When it was being looked at, it was clear that one of the points at which people were being lost was after basic specialist training, BST, and before higher specialist training, HST. The reason for that was there was a bottleneck because more people were recruited into basic specialist training than into higher specialist training. The response to that by the HSE's NDTP was to try to make it less of a pyramidal structure and more of a funnel structure, so there would be the same number recruited at BST as at HST, and therefore graduating out as consultants. In theory, I understand why that would be the response to stop people leaving but what happens is that people who leave to do a fellowship, have a baby or train abroad and who want to come back are restricted from returning because of the funnel system. We used to have a pyramid system in which people would train for four years in BST. They would get their membership and would be partially qualified as specialists. They would be able to go abroad with marketable skills and there was clear competition to get into higher specialist training. There was a loss of some people but they could come back in and compete for higher specialist training later. Now it is much more restricted and getting into higher specialist training is more difficult if one does not run through. That is as a result of the HSE's NDTP's decision to change it from a pyramidal structure to a funnel structure. It is something we are trying but it can limit people returning.