Dr. Matthew Sadlier:

I will address the first two questions. On the added value of an agency locum, I do not want to be disrespectful to my colleagues. There is a value in having agency doctors who, on the whole, are very well trained and very well qualified medical practitioners. It is better to have a doctor in the post than not have one in the post but I have experience of a service where we have not been able to fill a post permanently for a number of years. Somebody will come in on a three-month contract but they cannot work beyond that because they have other commitments elsewhere. It is very difficult, therefore, to plan whether to book patients for the three months following that contract. We then get a backlog of referrals which are put to the side. If we manage to get the post filled, those patients go on the waiting list and so on. It is absolutely the case that the uncertainty in terms of being able to plan and run the service leads to a backlog in the waiting lists.

Specifically in psychiatry, where we may have community psychiatry departments with one or perhaps two consultants covering a small area, if there is a gap or absence in that area referrals become completely backlogged. We have seen that in child psychiatry services across the country, specifically outside the major urban areas. There are waiting lists in the major urban areas also but we have major problems with waiting lists outside those areas. They are services that had a small number of practitioners and if one is missing out of a team of three, the service is down by 33% but if one is missing out of a team of one, there is a 100% deficit.

On the issue of inefficiencies, I have said in this room on more than one occasion that it is to do with electronic patient records. If the Chairman asked me during the Sláintecare hearings or hearings on whatever the report was before Sláintecare, as a person working on the ground, the biggest difference that could be made to the Irish healthcare service, it is not Sláintecare or any of that. It is whether we can have an information management system that is not based in the 1990s. One could walk into an Irish hospital in 1890 and walk into one now and one would have the same information management system. Our outpatients records are paper-based. We receive letters, names have to be written into a diary, which is transcribed into another diary. One of the reasons for the delay when a patient comes into the emergency department is because it takes six hours to get that patient's charts from medical records. I work in north Dublin. For various reasons, people might go to Connolly hospital or might end up in the emergency department in the Mater hospital and to get their records from one hospital to the other we would need to hire the Secret Service. From my perspective, if there was anything that could be done to improve the efficiency of the medical service in this country it would be to have a proper information management system. That would definitely improve the efficiency of our service.