Ms Rosarii Mannion:

My name is Rosarii Mannion, national HR director of the HSE. I am joined by Professor Frank Murray, director for national doctors training and planning. I want to begin by thanking the Chairman and the committee for inviting us here today to discuss recent media reports that suggest that some 650 medical consultants are not registered in the specialist division of the medical register.

In March 2008, the HSE amended the qualifications specified for consultant posts to require registration in the relevant specialist division of the register of medical practitioners at the Medical Council. The consultant contract 2008 reflects this requirement, the details of which were contained in HSE HR circular 021/2017 concerning qualifications required for consultant posts. The effect of this is that applicants who are not registered in the relevant specialist division cannot be appointed to a permanent consultant post in a HSE hospital or service or in a section 38 agency funded by the HSE. The rationale for the change was the imperative to ensure that consultants employed in the public health system have the appropriate training, skills, competences and qualifications to deliver care as assessed by the Medical Council, which has the statutory role of protecting the public by promoting the highest professional standards amongst doctors practising in the State.

It remains the case that there are a number of consultants employed who are not registered in the relevant specialist division. As of 14 April, this number stood at 127 out of a consultant workforce of 2,977 whole-time equivalents, or 4.3% of the workforce. This number can be broken down into two main cohorts.

The first cohort consists of consultants employed prior to 2008. There are 52 consultants in permanent employment who took up their posts before the introduction in 2008 of the contractual requirement to be registered in the relevant specialist division. This represents 1.7% of the consultant workforce. Of this number, 49 are employed in acute hospitals, one in the Irish Blood Transfusion Service, IBTS, and two in mental health services.

The second cohort comprises consultants employed post 2008. There are 75 consultants currently in employment who took up posts since the introduction in 2008 of the contractual requirement to be registered in the relevant specialist division. They represent 2.5% of the consultant workforce and are on short-term specific purpose contract, SPC, basis, a short-term locum basis or are engaged through an agency. SPCs are used to fill permanent vacancies pending the filling of a new or replacement consultant post on a permanent basis after the necessary approval from the HSE’s consultants appointments advisory committee, the selection process at the Public Appointments Service for HSE posts or within the section 38 agency, and the post-recruitment formalities of reference-checking, Garda vetting, and pre-employment occupational health status assessment. Short-term locums are either employed directly by the HSE or section 38 agency, or are engaged through an agency in instances where cover is required for the annual leave of permanent consultants or for other temporary absences. It can often be the case that appropriately qualified consultants registered in the relevant specialist division do not present as applicants for short-term locum posts or for SPC posts pending the filling of a new or replacement permanent post. Service requirements have therefore led to the engagement of the consultants in this category. HR circular 21/2017 details requirements for consultant appointments. I have set out in the opening statement the breakdown by hospital group and community healthcare organisation, CHO, of where the consultants are appointed. I will not go through it, but the committee members have that information to hand.

I will now outline measures to address the issue, starting with risk mitigation measures. The national clinical adviser and clinical programme group lead for mental health has sought and received assurances from the executive clinical directors in mental health services of risk mitigation measures, to include oversight of the practice of post-2008 consultants not in the specialist division. Similarly, within acute services, hospital managers and clinical directors have put in place monitoring arrangements appropriate to the circumstances of the practice of post-2008 consultants not in the relevant specialist division.

A further measure consists of incentivising eligible pre-2008 consultants to apply for specialist registration. The acute services division and the mental health services division are working to establish which of the pre-2008 consultants would be eligible for registration in the relevant specialist division on the basis of their having completed higher specialist training or equivalent. As a once-off measure, the HSE will fund the Medical Council directly for the cost of the application process, such that the consultant will not incur any personal expenditure.

I refer also to upskilling post-2008 consultants who have not completed higher specialist training. Colleagues in mental health are engaging with the Royal College of Psychiatrists to explore additional competence-based training for consultants to allow them to apply for specialist registration. This approach will be a more complex issue in the acute services, given the greater number of consultants involved, the greater number of specialties, the procedure-based nature of training in some of those specialties and the greater number of training bodies etc.

The HSE is also minimising the timeline for filling new or replacement permanent consultant posts.

Clinical directors in mental health services and acute services are seeking to clarify the position with each post-2008 consultant post currently filled, by definition on a non-permanent basis, in order to establish where the post is on the continuum from approval at the consultants advisory committee for a new or replacement post, to advertisement, to shortlisting and interviewing at the Public Appointments Service, to post-selection formalities undertaken by Health Business Services recruitment prior to the offer of a contract. The aim is to identify any impediments at any stage of this process with a view to elimination of these or otherwise to minimise the impact on the timeline for filling new or replacement permanent consultant posts. The hospital groups’ HR leads will work with the HSE national doctors training and planning’s doctors integrated management e-system, DIME, to access real-time data contained within DIME to allow full compliance with consultant specialist registration requirements and to ensure in the interim 100% compliance with the matching of approved posts on DIME to all occupied posts in the hospitals.

The recent appointment of an interim chief clinical officer will assist the delivery system to address the issue. Addressing the issue is a key priority for the HSE. Work is ongoing between the HSE, Medical Council and training bodies to address issues which I anticipate will be concluded at the earliest opportunity.