John Crown (Independent)

I do not want to sound like a broken record and I am aware that the magnitude of the crisis involving non-consultant hospital doctors has exercised many of my colleagues in this and the other House over the past several weeks. However, I ask the Leader to bring to the attention of the Minister for Health that little debate has taken place in this House or in any other public forum in regard to the fundamental cause of the problem. We will have a net shortfall of approximately 400 non-consultant hospital doctors manning front line services as of the next scheduled calendar turnover, which will occur in the second week in July. This will have catastrophic effects across the health service but will be particularly acute in accident and emergency departments. There already has been speculation that individual units may be closed or curtailed as a result. While we have heard considerable discussion about the various Band-Aid solutions being offered, such as sending teams of recruiters to take young doctors from India and Pakistan to work in our emergency rooms, geriatric wards and surgery departments or encouraging the Medical Council or other statutory and licensing agencies to make it easier for doctors to enter the country, there has been a lack of debate about the fundamental problem, namely, the dependence of the health service on trainees to provide front line services. We should regard junior doctors as having three functions - first, training; second, training; and, third, training. That is all they are there for and their presence or absence should have no effect whatsoever on the conduct of the health system. Those jobs should be educational. Sadly in Ireland, we have a track record of taking people into those jobs and making them work under consultant rank to provide services disproportionately to public patients. It is not an issue of pay because they are paid relatively well but they are not given the appropriate career prospects.

My colleagues may not be aware that Ireland has the highest number of medical schools per head of population. We have six schools for 4.5 million people. The average in Europe is approximately one per 1.5 million people and in North America it is one per 2.5 million. How can a country which has one medical school for 750,000 people have, on the other side of the coin, the smallest number of career level doctors per head of population of any country in the western world? That is the fundamental problem. People believe it is due to the actions of a medical cosa nostra or closed shop but, I can speak with authority for the hospital system, one group of people in this country control the number of career level posts, namely, the officials of the Department of Health and the HSE and the Government. This is not a party issue because it has been the same case with successive Governments. A deliberate decision has been made to base policy on the premise that we will have a low level of career jobs.