There are so many things about the rules that govern the recruitment of doctors and medical staff in the State that are dysfunctional that it is difficult to know where to start.
We know that Ireland has one of the highest reliances on foreign-trained doctors in the world and, yet, at the same time it has one of the highest rates of emigration among Irish doctors trained at home.
Ireland also has one of the lowest numbers of practising doctors in the EU, with a particular dearth of consultants. The result leaves one million people on waiting lists and creates lengthy delays for appointments and operations.
However, this is only the start of the problem. Up to 450 consultant posts lie vacant. Meanwhile, 134 doctors on the general register of the Medical Council, and who have not trained as consultants, are employed as consultants.
These issues are worst in smaller hospitals – in South Tipperary General Hospital, for example, 11 out of 31 doctors on the general register are employed in consultant posts.
Forensic detail
Huge changes have occurred in recent years, to the possible detriment of patients and services, as this draft Health Service Executive report obtained by The Irish Times shows in forensic detail.
Within a few short years, the service has become hugely dependent on a category of junior doctors, most of them foreign-trained and on the lower rungs of the medical career ladder.
More and more healthcare is delivered, not by consultants or trainees in secure career structures, but by an ever-growing army of “non-training-scheme doctors”.
Most are foreign and trained abroad, stay only for a few years and constantly rotate between short-term postings while in Ireland. They are the workhorses of the hospital system.
The system leaves them ill-served. Many are excluded from training schemes and are unable to be credited for the prior experience. They are left disenfranchised, disengaged and unfairly treated.
Many are voting with their feet, moving to the UK in the hope of better chances of becoming a consultant. In turn, it leaves the Irish system all the more reliant on new tranches of foreign staff, treated equally poorly.
Agency costs
The current situation is unsustainable, the report says. It predicts patient safety being compromised, services being discontinued and agency costs rising to unsustainable levels if nothing is done.
Yet doing nothing seems to be the approach. Written by senior medical decision-makers, assisted by experts in business, manpower and medical education, the report was completed last January but has yet to see the light of day.
It has taken the President of the High Court, Mr Justice Peter Kelly, to highlight our "defective" procedures for recruiting doctors and the danger these present to patients over recent years.
The Irish Hospital Consultants’ Association is currently running a campaign to show how understaffing, difficult working conditions and pay inequities are affecting patient care.
Yet the Health Service Executive seems unwilling to publish a report illustrating the size of the problem. Fixing it would cost, and dearly, but merging services in a more rational way, as proposed in the report, would be politically controversial. It would be disturbing if these considerations had anything to do with the fact that the report has yet to see the light of day.
