Pat Buckley (Cork East, Sinn Fein)
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I have heard a great deal in committees over the past two years. Today, I am just in shock. The opening statement states: "In short, the Irish health service is uncompetitive in recruiting and retaining the number of high calibre consultants it requires." If that is not a red flag, somebody is not doing their job. Last Saturday, hundreds of people marched in Tipperary because they have no mental health services. I had the honour of speaking at an event there a couple of weeks ago. More than 200 pairs of shoes were put on the stage. They represented people, not patients or statistics. If we include Tipperary and work on a 32-county Ireland basis, there are 16 counties that could not hire consultant psychiatrists in 2016. That is 50% of the country.

Mr. Hughes referred to 500 vacancies and the possible 1,700 who will be retiring in the next four or five years. That is a possible deficit of 2,200, or 2,204 if we wish to be politically correct. It is shambolic. I looked at the document on doctors in training and planning. It refers to supply and demand for consultants in the workforce between 2018 and 2028 based on the ratio of 12 consultants per 100,000 of the population. The extra demand to achieve the recommendation for 2028 is an additional 16 each year in 2018, 2019 and 2020. For the years 2021 to 2027, inclusive, it is an additional 15.

Underneath that, however, it tells us that 20 are going to retire in 2018, 20 in 2019, 20 in 2020, 21 in 2021 and 21 in 2022. In other words, the plan is to hire an additional 153 up to 2028, but we are going to lose 207 by 2028. That will leave a gap of 144 consultants. That is a fabulous plan. We then wonder why things are not happening. I am no mathematician, but since I have come here, I have said it is necessary to be an accountant to do the figures. It is not personal, but this has to come out at committees such as this in order that everybody can take it back and take responsibility. I refer to the consultant application process. The current process, following the letter of approval, applies to HSE hospitals. There are 12 stages. After the 12th stage, if someone is picked as a consultant, it takes a year to have the post filled. How long does it take if there are 11 stages before that to go through?

Turning the document over and going to voluntary hospitals, there are five stages. There has to be something wrong and complications. As Dr. Moore mentioned, there are five managers for four staff. A sweet shop, an ice cream parlour or a bakery would not have five managers and four staff. It is not a comprehensive model. Please excuse me - an emotional note can be heard in my voice. I will try to be brief. Again, this is not a personal attack, but I am fed up of listening to talk about the commissioning of reports on recruitment. It is not rocket science. We train them here; we pay them here and we keep them here. That is being lost to society. What is happening is that funds are being diverted into management and it is not patient-centred. Again, it is the patient who is suffering.

Between 2000 and 2002, in my little pocket in east Cork we buried 69 people who died by suicide. It is that serious, which is why I want the delegates to get the picture. Last week I dealt with the case of a mother who had taken her own life, leaving five young children behind. We have mothers who have children with autism spectrum disorder, ASD, and are suffering from mental health issues. They are making cages to keep their children in their own homes. It is to keep not only the children safe but also the parents. I have dealt with cases at CAMHS in which kids under 16 years of age have pulled all of the hair out of their head, yet they cannot get into the service. They are banging their heads against the wall.

There are two major issues. The plan for recruitment is kerfuffle. That is the word I will use. I love all of the work time equivalents and so on, but there does not seem to be concrete forward planning. It goes back to the numbers of retirements and recruitment. Nobody within the system wants to plan, but there has to be a database containing the dates of birth of staff; therefore, it is known when they are going to retire. However, there is no forward planning. The HSE waits for staff to retire; then heads are scratched and it is realised, reactively, that there is a post to be filled. We know how toxic it is inside the system.

The staff are the bread and butter of the system. This committee was set up to help the system and service users. I want to ask one more question. I thank Dr. Moore for his honesty and do not want to put him on the spot, but I have to do so. If it is possible to be frank and honest, how bad is the system? I have asked this question before. If we do not have a proper recruitment plan, there is a possibility that in five years we loe lose 2,200 staff. In 50% of the country it is a struggle to fill posts. Does Dr. Moore see a national emergency or a national epidemic, as we will call it, of suicides in the next four to five years?