Dr. Kieran Moore:

I have a slight throat infection so my voice is a little low. Before the HSE was set up I was directly involved in recruiting people on the team. That was very helpful. I have no say whatsoever since then. The consultant contract is very clear that the consultant should be involved in the recruitment and retention of staff on the team. That has been flagrantly breached by the employer because we are never involved. People are recruited nationally and put on the team. Sometimes people are fantastic but sometimes they are not and the fit does not work.

Second, I could speak forever about the barriers but I am aware of time. I will take a slightly different angle to it, as a human being. I was in Galway recently for my nephew's Holy Communion and one of the things the children were being taught about was carthanacht agus cúram - care and love. It was in the Gaeltacht so it was all in Irish. Without going overboard, that is what we are supposed to be doing. We are supposed to be caring for patients. I have heard almost nothing about patients in all of this. With due respect, and this is not directed at any person, we are talking about complex situations and all sorts of barriers that are put in place. Ultimately, all of us who work in the health service need to see patients all the time. I am not blaming individuals but there is a management structure and the system does not work.

In Wexford, where I work, there are five managers. None of them is clear about what they do. I asked them but there are no job descriptions, or if there are I am not allowed to ask. I have asked them numerous times to come and meet the team, which is one sixth of what it should be, but they have not done so. When there are questions from patients they come to me. I tell them to ring the parents and ask them. I ask them to come and meet some of the patients. If that were done we would all realise what the situation is. What I hear at national level is so far removed that I do not have a clue. It is never sent down to me. In terms of budgets, I have heard there is no issue with funding. That is absolutely not true. Whatever the issue is, decisions are made by people who have no expertise in the area and we are told after the fact, if we are even told.

They are the barriers. Fundamentally, most of the different people who work in the health sector care when they go into it. It is not just consultants but also doctors. We go into it because we care, but much of the time we are treated with contempt. There is no understanding. We get misses after misses. I work in a place where there was a fastened noose left behind after an IT refurbishment. It was a piece of wire fastened in a noose, although not deliberately. It was left there for weeks. I asked numerous times for it to be removed. I would have done it but I probably would have electrocuted myself or caused a health and safety problem. On numerous occasions I let people know about the risk but nothing happened. I even took photographs as well. These are just the elements. Patients are coming into a building that is in a state because staff are burned out. All of us are human beings. Honestly, the one thing that works in staff recruitment and retention is if people feel valued, and they do not. The systems are important as well. Devolving locally would help.

I happen to be one of the people who is resigning. I am resigning from Wexford because it is untenable and unsafe. Two of my colleagues are doing the same. I do not wish to bring it down to one area but there are five managers and I do not know what they are doing, with all due respect. I do not wish to blame the managers alone but if people met with patients and understood, we could do things differently.