Eamonn Maloney (Dublin South West, Labour)
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As a member of the Oireachtas Committee on Health and Children, I endeavour to take an extra interest in such issues. I refer specifically to the research published today in the online journal, Human Resources for Health, and which was overseen by NUI Galway. Some might describe the evidence presented in the study as alarming and some as shocking. A total of 2,273 medical students were surveyed, of whom 1,519, or 67%, were classified as Irish medical students, having completed secondary school in Ireland. The remaining 33% were non-Irish. What is of concern are the figures showing that 90% of the medical students "may" leave this jurisdiction having completed their medical education. Like all politicians, I have some scepticism in that, if we were to rule our lives on the basis of such studies, we would not move too far. Notwithstanding that, if the figure is anything near to 90%, by any yardstick, it would be a matter of concern for us all, including the Minister, Deputy Varadkar.

I am reminded that the taxpayer paid approximately €75 million last year for those engaged in medical education. In the lifetime of a medical course, the cost to the taxpayer is €125,000 per student. I am not suggesting in any way that we should intern them or nail them down but, given the difficulties in the health system and the lack of funding as a result of the country being destroyed, we must examine this issue.

Is the situation as bad as is portrayed in the study or is it more optimistic? If it is not, what is the Minister's advice for rectifying the situation? When I heard the Minister speak recently in the House, he told us about the lack of anaesthetists and the difficulties over pay, and the fact they will not stay because their experience is more extensive than just being qualified as a doctor. Is the situation as bad as is portrayed in the study?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for raising this important issue. The recruitment and retention of doctors at all levels, from medical student to specialist, is important for me as Minister for Health and I am committed to the implementation of the recommendations of the strategic review of medical training and career structure, which was chaired by Professor Brian Mac Craith. Through its various reports, the strategic review working group has offered solutions and recommendations, which, if we see them through, will ensure that we build a sustainable workforce for the future.

I recently received the first progress report on the implementation of the recommendations. I am pleased to say there has been a range of developments which will, I believe, help us recruit and retain doctors, including newly qualified doctors, in our health service.

As the Deputy will be aware, on foot of the working group's recommendations regarding consultant career structures, associated proposals for new salary scales for new consultants were recently supported in a ballot by IMO members. Since then, the HSE has moved quickly to advertise positions with new payscales and there has been considerable interest. I expect that these new scales and improved salaries will help us to keep more of our graduates at home and persuade consultants who are working overseas to return to Ireland.

With regard to the quality of the training experience, there have been a number of developments which I am confident will have a positive impact on the day-to-day working lives and experiences of our trainee doctors. For example, an agreement was reached last summer among health service management, staff associations and the training bodies on protecting training time for trainees. The HSE has issued guidance on implementing this agreement to clinical sites, and I expect that all sites will adhere fully to the agreed annual limits for interns, specialist trainees and other non-consultant hospital doctors on professional competence schemes.

In future, trainees will also have greater predictability regarding their rotations at the outset of their training schemes.

4 o’clock

Most of those commencing basic specialist training this summer will know their rotations for the next two years, and I understand that the HSE and the training bodies are working closely to introduce pre-defined rotations for higher specialist training this July, where they are not already in place. I also see the national implementation of the lead NCHD initiative as a very important step. This initiative was piloted in five hospitals in 2014 and has been expanded to a further 26 hospitals for 2015. The lead NCHD role provides an important link at management level between NCHDs and hospital management. While these are all positive and welcome developments, more remains to be done to implement the full range of recommendations. To support implementation, my Department has established a monitoring group comprising key stakeholders, including trainee doctors. This will help us to drive implementation across the system and embed the recommendations in the day-to-day business practice of the health service.

The first six-monthly progress report was published on my Department's website on 5 March, and I look forward to receiving the next report at the end of June. The report will also be published online so that all stakeholders, particularly trainee doctors, can assess the progress we are making. Finally, it is important to point out that, notwithstanding problems we are having with recruitment and retention, the number of consultants and NCHDs employed by the HSE is at an all-time high and the number of GPs contracts in the HSE is close to an all-time high.

Eamonn Maloney (Dublin South West, Labour)
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I thank the Minister for the more optimistic conclusion of his contribution than is indicated in the study. One of the difficulties is that historically there has been a transfer of people who qualify in medicine in Ireland. It is an historic problem and is not terribly new. I know from my previsions involvement with a committee in my local hospital in Tallaght that different medics have different views on why people leave the jurisdiction. Some say it is because of remuneration, while others say they go to certain places such as America and Australia. One also meets people, as I did in my local hospital, who came back after a very short period of time and are working in the Irish medical system, which is encouraging.

Leo Varadkar (Dublin West, Fine Gael)
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I am disinclined to comment in detail on the study because I have not had a chance to read it; I have only seen online coverage today. I would speculate that if one did a similar survey on many other professions one might get a very similar result. It has always been the case that people migrate, something which is truer now than ever before. We have a long history of doctors migrating to Ireland and from Ireland to other parts of the world, sometimes to get experience with a view to coming back. Others want to work in international centres such as the Mayo Clinic or the Memorial Sloan Kettering Cancer Center, which will never exist in Ireland.

It is important that we achieve an equilibrium so that similar numbers come in and leave. That requires remuneration, and we now have agreement on consultant pay with the IMO, with new salaries being offered. A left-led Government could propose to impose high taxes on people earning over €100,000. That, along with the risk of pay being capped at €100,000 or a 60% tax rate above €100,000, is a potential threat to our health service and would certainly leave patients at risk.

We need to improve the experience of working in our health service. It is a difficult place to work for many people - not just doctors but other health staff. The fact that doctors will know their rotations two years in advance is very important. They will know where they will live in six months' time. It is a simple thing which is now being done. The fact that they will have dedicated protected training time when they are off-bleep is very important. A lot more can be done in those spaces.

Michael Kitt (Galway East, Fianna Fail)
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Is the Minister taking any other Topical Issues?

Leo Varadkar (Dublin West, Fine Gael)
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I am taking three.

Clare Daly (Dublin North, United Left)
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There is no Minister to take our Topical Issue. We have agreed with the Department of Foreign Affairs and Trade that it will be taken on 24 March.