Dr. Donal O'Hanlon:

I thank the Chairman and committee members for the opportunity to address them on the processes involved in recruiting consultants to work in mental health services. The association represents 85% of the hospital consultants who work in acute hospital and mental health services.

It has been recognised for some time that there is a clear need to simplify and speed up the processes involved in recruiting consultants to work in mental health services, and how consultant posts are established, advertised and filled throughout the health service as a whole. It is important to note that complications and difficulties with the recruitment process are not the fundamental problem that causes our current consultant recruitment and retention crisis. This deep-rooted problem is the result of the failure of the State and employers to honour consultant contracts and the imposition of the new terms and conditions placed on new entrant consultants. This has been exacerbated by the FEMPI cuts applied to salaries and systemic funding shortfalls in psychiatry and mental health services over the past decade.

The health service is uncompetitive in recruiting and retaining the number of high calibre consultants that it requires. This sharp decline in competitiveness is evident from data supplied by the Department of Pubic Expenditure and Reform in a submission to the Public Service Pay Commission last year. The data indicated that psychiatry has 31% of its permanent posts either vacant or filled on a temporary basis, and of the 44 psychiatrist posts advertised in 2015 and 2016, practically a quarter had no applicants and 30% had only one applicant. There were 16 consultant psychiatrist posts interviewed for in 2016, including posts in child and adolescent psychiatry, learning disabilities, forensic psychiatry, general adult psychiatry, and psychiatry of old age, but no applications were received. The competitions that had no applicants were for mental health services posts in Sligo-Leitrim, Cavan-Monaghan, Cork, the Central Mental Hospital, Carlow-Kilkenny, Donegal, Longford-Westmeath, Laois-Offaly, and the Waterford-Wexford. In effect, the health service no longer competes in an internationally competitive recruitment market for specialist medical consultants.

My association's previous submission to the committee highlighted three separate expert reports that were compiled over the past decade or more. They all confirmed that the current number of approved consultant psychiatrist posts is significantly below the level needed to provide safe and effective care to patients. The Hanly report, the HSE national doctors' training and planning unit and the College of Psychiatrists of Ireland report all recommended significant increases and up to as many as 858 consultant psychiatrists by 2020. Of the existing 420 approved consultant psychiatrist posts, only 290 have been permanently filled.

In addition to the overwhelming problem with uncompetitiveness, due to the breach of contract and discriminatory salaries imposed on new entrant consultants, other issues impact on recruitment. These secondary issues have been assessed in the HSE-commissioned report entitled, Towards Successful Consultant Recruitment, Appointment and Retention, which was published in February 2017. Notwithstanding its strict terms of reference set out by the HSE director general, the executive summary stated that, "simply correcting and providing rigour to the recruitment and appointment process was not of itself enough to address the present Consultant recruitment crisis but that other factors also needed to be addressed". These, the report noted, included shortfalls in consultant numbers and the availability of consultants, working conditions and "most particularly, concerns regarding remuneration". The report described the discriminatory new entrant salary scale as a "source of concern to candidates as well as a potential source of intra-departmental disharmony and a disruptive influence on the need for good team-working".

The Keane report also identified deficits in the current recruitment process, including a disconnect between posts approved and training programmes, as well as limited engagement with trainees on forthcoming opportunities. The lengthy periods to progress applications for the approval and advertising of posts was also highlighted, involving multiply bodies such as hospitals or agencies, the consultant appointments advisory committee, CAAC, the national recruitment service and the PAS. The arrangement of interview boards has also caused delays. However, this debate is largely academic if no applicant or just one turns up for an interview.

Some progress has been made on the 38 recommendations in the Keane report but we have yet to see significantly shorter timescales for key aspects of the recruitment process.

The reduction in consultant psychiatrist posts advertised – down from 32 in 2015 to 12 in 2016 – is also a significant concern, suggesting that vacant posts were not advertised because the HSE did not anticipate that they would be filled.

The association believes there is an over-reliance on national HSE panels to recruit front-line mental health staff, rather than creating panels for specific posts. This should ensure a more focused post-specific recruitment process and negate the inherent problems with the formation of national panels. Waiting until a vacancy occurs to begin recruitment is poor practice but all too common. As a result, greater anticipation of the opportunities occurring due to retirement must be built into the recruitment system at a much earlier stage to reduce the gap between a consultant leaving the mental health services and the replacement taking up the post. Proper succession planning is vital in any business or organisation. However, while this would be beneficial in circumstances where we are competitive, in the current breach of contract and new entrant discrimination environment it is expected it would lead to more posts with no applicants.

Data from the World Health Organization, WHO, confirm that Ireland currently has 6.1 consultant psychiatrists per 100,000 population, the fourth lowest out of 26 OECD countries. This is nearly half the EU average number of consultant psychiatrists. Not alone is the psychiatry service unable to fill advertised posts but it appointed 21 non-specialists to consultant psychiatrist posts last year across all psychiatry specialties in ten mental health services. This undermines the safety and quality of patient care and the provision of services.

The failure to fill consultant psychiatrist posts is severely undermining the quality and quantity of the psychiatry service that can be provided to patients. The health service's uncompetitiveness in recruiting and retaining consultant psychiatrists is the fundamental problem that needs to be addressed far more than the recruitment processes. I thank the committee for inviting us to today's discussion.