Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

In percentage terms, it was not dissimilar to the kind of overruns we have now. The record for the biggest health supplementary ever was under a Fianna Fáil led Government. About €1 billion had to be provided in a supplementary because of illegal nursing home charges, of which the Deputy will also be aware.

On the recruitment of doctors, all the questions asked by Deputy Burton were asked by Deputy Shortall earlier but I am happy to do her the courtesy of giving the answers again. The Deputy is correct that we have one of the lowest numbers of doctors per head of population in the OECD. Ireland has a relatively low ratio of doctors to patients. In contrast, we have one of the highest ratios when it comes to the nursing profession. We are in the top three, four or five in terms of the number of nurses we have per head of population. I agree that we do not have enough doctors working in our public health service but we do have more than ever before. This often does not come across but there are more doctors now working in our public health service than ever before and more doctors are registered with the Irish Medical Council than ever before. Sometimes the impression is given that there are more doctors leaving the public health service than are joining it but that is not correct.

There are more joining it than leaving. The HSE and Medical Council numbers show that. Overall, the number of people working in the health service has increased by 10,000 over the past three years. It is up from about 105,000 to 150,000 across the public health service. One of the reasons we have overruns in the health service is the recruitment surge rather than the recruitment crisis and the fact that extra people are hired every year beyond what is provided for in budgets.

On the number of consultants working in the public health service, as I said, this continues to grow year on year. The number increased by 109 in the past 12 months. There are, however, significant recruitment and retention challenges, especially in certain specialties such as psychiatry where we need to move to a more psychology based model. It will not be possible to find the number of consultants needed using the current model. In certain locations - some smaller hospitals - particular posts are no longer recognised for training purposes and probably never will be.

The HSE recently prepared a report in response to a request from the Minister for Health, Deputy Harris, and the Department of Health to consider the issues raised in the judgment of Mr. Justice Kelly and given the current recruitment challenges. I understand this report and recommendations were submitted to the Department of Health on 13 May and are currently receiving consideration. They will be published as soon as possible.

Several initiatives are being pursued by the HSE to advance consultant recruitment and retention, including improvements to the recruitment process, which is very cumbersome; offering contracts to the hospital groups rather than individual sites; and focusing on more family friendly arrangements such as job sharing and part-time contracts. The HSE has also established a tripartite working group, including the Medical Council, the forum of postgraduate medical training bodies and the HSE's national doctors training and planning unit, to examine posts where consultants are not on the specialist register and recruitment and retention challenges exist.

While several hundred consultant posts are difficult to fill at present, only 20 are currently being advertised. The reason is that many of the posts are filled on a locum or temporary contract basis to ensure the delivery of essential services. While we describe the positions as being vacant, they are not actually vacant in the sense that the job is being done by somebody on a temporary or locum contract rather than someone on a permanent contact.

On the issue of new entrant consultants' pay and the proposals of the Public Service Pay Commission, the Department of Public Expenditure and Reform has said that outstanding matters will be given full consideration by any pay review mechanism agreed by the relevant parties in the context of the next round of pay talks. In the past few months, we secured a new contract for staff nurses and staff midwives, with pay increases and changes to practices and terms and conditions. We have also successfully agreed a new contract with general practitioners to increase funding for general practice by 40%. In return for that, there have been agreed changes such as the adoption of new technology and GPs taking on new work, especially around chronic disease. In negotiations with consultants we will need to adopt a similar approach in which, in return for equalising pay, we ensure it is not just more pay for the same outcomes and changes are made that are patient focused. It must also deal with some of the very difficult and problematic issues around the mix of public and private practice.

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