Colm Burke (Cork North Central, Fine Gael)
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I have some students from UCC as my guests. I hope the witnesses' replies will not be too negative or the students might find they have to leave the country because we are getting too negative here about a lot of things.

I want to refer to Medical Council figures. I am intrigued by how we are commenting on medical practitioners in this country. My reading of the Medical Council figures is that, five years ago, there were 19,046 medical practitioners on the Medical Council register, and the latest figures for 2018 show there are 22,996, which is a 20.72% increase. I am intrigued because all of the media focus seems to be about the shortage of doctors yet there has been a 20% increase in the number working here, or who are on the medical register, most of whom I presume are working here. For instance, the number of junior doctors has increased quite substantially in the hospitals because of the working time directive but no one is talking about that. Much of what is being said is very negative and one negative creates a second negative. I am concerned about the negativity in regard to recruitment. I accept there are issues in regard to some of the doctors coming in, such as those relating to their previous training and experience, which I fully understand.

The second issue relates to consultants. I would like clarification on the number of consultant posts five years ago and the number now. Taking the number of consultant posts now, how many are occupied permanently and how many are occupied by agency or locum consultants?

My understanding is that five years ago, approximately 2,500 permanent consultants were working in the system but that number is now approximately 3,000 while another 500 posts remain unfilled.

We can go back 20 years regarding recruitment as there was a system in place where a consultant was reaching the age of 64 or 65. It was flagged within the hospital system that it needed to plan to replace that person, organise advertising and ensure somebody would be committed to taking up the job when the consultant retired. That all seems to have collapsed as the process was absorbed into the HSE. It is astonishing that positions after being advertised after a person has retired. This relates to agency and locum staff as the people who have retired may have to come back to act as a locum. Has the IMO approached the HSE about fast-tracking the process and planning? There is a lack of planning within the HSE with respect to the recruitment of consultants, which is adding to the overall problem.

Agency and locum staff cost three times as much as employing someone on a contract. I disagreed at the time with the 30% reduction that has been mentioned. I did a report in 2012 about graduates from that year. We interviewed them across all universities. A total of 60% indicated that they would leave Ireland within 12 months once the intern year was done. That report was done in addition to a report by the health committee but I am astonished there was no take-up on it by the HSE with respect to forward planning.

Retaining junior doctors is a major issue. Allowances were cut back so what has been restored? This is not about salary or anything else but rather simple elements such as days allowed for study. How much progress has been made in restoring what they had previously? What more could we be doing to make it attractive for junior doctors to stay here? We are not doing enough about that and the HSE's approach is not correct either. The approach from certain elements of HSE management is to tolerate junior doctors but if the position was made more attractive than in other jurisdictions through the provision of allowances and study leave, we would have a greater chance of retaining them in the system. What simple measures could be taken? There would not be a major cost. There are more than 6,000 junior doctors in the hospital system and many of them want to study in various other areas.

I raised a matter with the Medical Council last week about doctors dropping out of the system and I was a bit taken aback by the response. I was speaking to a medical practitioner recently about two people doing obstetrics and gynaecology. One had done nine years of training and the other had done six years. They have now dropped out and returned to GP training. I am not saying the GP system is easier but there is not the same level of stress. We discussed adverse events and the lack of support within the hospital system for doctors and nursing staff. I have heard about nursing staff facing an inquest without being given any support before or after the hearing. It is not that anybody did something wrong but that the experience is traumatic.

There are 135,000 people working for the HSE and the number of whole-time equivalents has increased across the board, including nurses, doctors, administration and management. I have a major issue with administration and management. That means an additional 16,000 whole-time equivalents are working in the HSE compared to December 2014, which is a 17% increase. I am surprised by the lack of challenge from the medical organisations to the disproportionate increase in administration and management compared with medical practitioners and nursing staff. I had to extract this information over a period. I am very much ploughing a lone furrow on this. There was a 24% increase in administration and management but an 11% increase in front-line nursing staff. I am a bit concerned as we need to have a bit more joined-up thinking across the board but there must be a challenge from within the system as well as outside.