Professor Frank Murray:

The point Ms Mannion made is correct. Frequently, service providers such as hospitals or mental health services, must make a decision about whether to provide no service or to provide a service with somebody who is not on the specialist division of the register acting at consultant level who frequently, I think, has comparable experience, if not certified training, with those individuals who have registered with the Medical Council on the specialist division of the register. That is one of the issues that is quite important to think about. They are not doctors who, in my experience, do not have relevant experience and training. They are doctors who do not have certification in that regard, which is different. As Ms Mannion has outlined, they work in a slightly different environment where there is more mentoring rather than stand-alone work, as consultants tend to work. It is worth thinking about where these posts are located. They are mainly in smaller level 3 and 4 hospitals, in community mental health services and in hard-pressed specialties such as anaesthesia, surgery and medicine. When there is a recruitment and retention issue, which we have discussed, one will see the crises most obvious in areas that are difficult to recruit into in Ireland, which mirrors the situation abroad.

There was a question as to whether this pertains anywhere else. Scotland has a much worse recruitment and retention issue than we have. They have an awful lot of posts unfilled. Frequently, it is the remoteness and the unattractiveness, or the relatively less attractive nature, of the specialty that has worsened the recruitment and retention crisis and put pressure on the service to provide alternatives.