The part Kenny show on news talk with Marter private network during current restrictions. Don't ignore your health concerns. Our expert team is ready to help. A million hospital appointments or thereabouts have been cancelled by the pandemic. It's a pretty shocking statistic. It's part of an analysis from the Irish Hospital Consultants Association, which highlights the massive told the pandemic is taking on numb covid patients to understand how this situation has mushroomed over the last year. I'm joined now by a member of the National covid-19 GP Liaison Committee, former president of the Irish Medical Organisation, Dr Rachel Ray.

Good morning. Good morning.

Now let's talk about how the numbers were at the beginning of 2020 before the pandemic struck. How bad were things then?

And, you know, in terms of year on year increases, how have we fared in the 12 months?

Well, understandably, with the especially level five lockdown, many outpatient clinics have been cancelled, many orthopaedic operations and other operations have been cancelled, and as a result, patients haven't been seen. Acute issues haven't been semi acute. Acute issues are still being dealt with in emergency department, but semi acute issues haven't been dealt with. And chronic care has been a knock on effect of that is, is that people can get sicker or people suffer more or both.

And as a result of that, you've got longer waiting lists, but equally prior to the culverts, because covid can't be blamed, it can be blamed on all of this. We did had lengthy waiting times. We had in the order at the end of, I think twenty twenty or twenty nineteen and the order of 750000, 850000 people on waiting lists. And up till around October last year, we had vacancies or consulting posts to the order of seven hundred and twenty eight and being held by either vacant or being held by people in temporary position.

Now the important thing about that is if that's 700 or thereabouts positions which are sanctioned to be filled and we know that there's a huge shortage, even when all of those are filled, there's a huge shortage of consultants. So it's not as if you found for 700 people that you still have a great health service.

No, if we look at the agency's projected the targets themselves and all of this is depressing to say in the fact that the U.S. believe we need 600 consultants presently, if you add in the absence of psychiatry places and public health, they say we need up to 2000. So 400 public health and psychiatry. And so on top of that, then we have a infrastructure which needs to be augmented. We need minimum presently about 2000 beds. And, you know, obviously a lot of this needs to take into account the new lessons that we've learnt in regard to infection control.

We're going to eat more rooms with, you know, single beds. We're going to need more distance to be able to assess people and care for people. And, you know, so it is something which we need to get working on. Now, we have loads of reports. We just need to do something with them. Now, we have been exporting our doctors, is that rate of exports still going on even in the pandemic, or are people kind of forced by dint of circumstance to stay here?

And no, I'm aware of interns who have posts to take up in Australia, Canada and the UK in July and August, and none of them have stopped. And, you know, part of some of these people go away is for extra training to learn from a different environment. But equally, you, I'm afraid, is as well known in many of these jurisdictions, especially Canada, America and the U.S. and U.K., U.S., and that you have teams supporting a consultant or supporting a junior doctor, like I'm aware of, for example, not too far away here in north Dublin, where a consultant came down from the north of Ireland to become part of a mental health team.

But he's the only member of the mental health team, whereas he left the job in the north of Ireland where he had a full team. And so and he did on family circumstances. But the problem is, is that equally the cuts of 2012 where you had the reduction in new entry consultants of 50000 has definitely made a difference. Like you're talking about people who are returning to self-imposed in their mid 30s, early, late 30s who who basically are giving up and consulting posts in other countries at higher rates of pay.

And, you know, the it's well documented that consultants salaries in Australia comes U.S. are 48 percent less than the average salaries, you know, versus Ireland. And, you know, these things have been compared and different things that our consultants tend to do have a certain type of contract to have certain obligations. So people, when they are comparing salaries, need to be comparing like with like. The question of comparing with our nearest neighbour, I mean consultants here, and we have to bear in mind the tax system as well, but if you take the top line figures, they're better paid here, even after at that reduction for new entry consultants, they're better paid here and there would be in the NHS.

Well, my particular speciality is general practise. And I can tell you in the UK that they have the same number of GPS now as they did back in the ratio of 1950s. The UK NHS has fought very hard in regard to the pandemic, but the problem is they have been similarly under-resourced the last two decades and the NHS is not the phenomenal service that it was when I trained her back in the early 90s. And the NHS is not a place that money professionals can go to the same extent as they did.

And so what we want is a health service that is going to develop and not one that is dying like the unfortunate NHS because it is is is being underfunded. And, you know, every day.

Would you riddle me this? We have people coming from, I suppose, the Indian subcontinent most noticeably, who are coming here to work and to train and to learn. And they're coming here because they see us as a centre of excellence, rightly or wrongly.

And then our guys are going off to learn somewhere else. You know, it seems bizarre that we import a huge cohort of people to buttress the health service that could be served by our own people.

Well, that is equally a criticism that we are not giving these people the respect that they deserve by appropriate training process and the appropriate ability to become consultants. But equally, they will have the same criticism that they are here from their own countries because their own countries don't have they're coming from less developed countries to a more developed country. But they will acknowledge equally that if they have the choice, they will further progress onto the other English speaking countries like New Zealand, Canada, America and Australia, because they are more appropriately resourced.

Like what we need to do is look how certain countries have all answered the fight of Colvert and learn from what they've done. Like, you know, even those well developed countries have had great difficulty like Germany and Holland. But all of those countries significantly fund their health care system for decades rather than the control system of funding that we have had. Like one country we would like to emulate is Holland, which loses none of its doctors to export because they fund the whole system on a turkey for to your method of appropriate levels at the highest level of health care system.

What we've learnt from covid is that unfortunately covid and other infectious diseases will seek out the deficiencies and the vulnerabilities in the health care system. And it's our most vulnerable who are elderly and people who don't have any funding to go into the private system who will suffer. That being said, our public system has provided heroic service in the last decade, in the last year. And we need to build on that because, you know, there's a lot of goodwill, there's a lot of lessons, there's a lot of better integrated teamwork that has worked certainly between primary care and secondary and tertiary care.

We need to learn on that and we need to go forward. We can do this. We need to start by funding appropriately and we need to resolve the crisis in general practise.

We certainly don't seem to have an appropriate number of general practitioners. I mean, there are people who simply don't have a GP because the lists are full.

Exactly. And again, with the HSC figures, they project out that we have 600 GP short. And that being said, true covid there was an agreement that if somebody presented with covid symptoms and a general practitioner would deal with the issue and that continues. But we have 600 GP's like we there are lots of studies showing out there, both in Ireland and the UK showing the burnout levels that we've got in health care personnel, including general practise. There's only a certain number of patients to any doctor can look after without necessarily their own health care suffering.

And the same is true of our nursing colleagues and other medical colleagues, you know, because the doctor kind of work with us as a team. And I remember many moons ago that if you had a consultant, you needed a million more for team to support him, then you needed obviously paid staff access. You know, we need to build on our infrastructure and there needs to be moderate. But we cannot take 14 years to develop the next bit of infrastructure as others have as a children's hospital.

All right.

On that note, Dr Ray, a member of the National covid-19 GP Liaison Committee, former president of the Irish Medical Organisation, thank you very much for joining us.