I propose to take Questions Nos. 189, 192 and 204 together.
There is some evidence that medical graduates are tending to emigrate on completion of training here and, to a degree, at an earlier stage. The reasons encompass a range of factors including training, work environment, career opportunities, lifestyle and quality of life issues and remuneration. Last July I established a group under the chairmanship of Professor Brian MacCraith to carry out a strategic review of medical training and career structures. The Group is to make recommendations aimed at improving the retention of medical graduates in the public health system and planning for future service needs. It provided an Interim Report in December 2013 focused on training. Last month the Group submitted its second report to me dealing with medical career structures and pathways following completion of specialist training. The final report of the Group will deal with workforce planning and this is due to be submitted by the end of June 2014. The work of the Group is fundamental to ensuring that consultant positions in the public health service are attractive to medical graduates. I have also emphasised to the HSE the importance of addressing the working hours of NCHDs and moving as quickly as possible to compliance with the provisions of the European Working Time Directive.
A proportion of nurses have traditionally gone abroad following graduation. More recently, given the moratorium on recruitment, the numbers going abroad had increased. The Nurse Graduate Initiative was developed in order to achieve savings on agency costs and to provide an opportunity for a substantial number of recently-qualified nurses and midwives to work in Ireland for a two-year period. This Initiative gives recently graduated nurses the opportunity to gain valuable experience and additional skills at a time when job opportunities in the public service are limited, though nurses continue to be recruited to permanent posts where service demands require this. Nearly 500 nurses and midwives have commenced employment in recent months on the Initiative, with over 200 others currently going through the recruitment process.
With regard to the numbers of nursing graduates required, a workforce planning exercise carried out in 2013 to forecast future staffing requirements as part of the Review of the Undergraduate Nursing and Midwifery Degree Programmes has indicated that the overall number of trainee nurses and midwives currently undertaking the programmes, 1,570 places in total, is considered to be sufficient to meet demand. With regard to medicine, in 2006, the Fottrell Report recommended an annual intake of 725 students into Irish medical schools based on the projected medical manpower needs of the health service. This target number has now been reached and sufficient intern posts are available to enable each graduate to register with the Medical Council of Ireland.
The ability of the public service to attract and retain high quality frontline staff shapes the extent to which the HSE can maintain and develop the range of health services required.
Where frontline staffing shortages exist, the HSE makes alternative arrangements to ensure service provision, including recourse to agency and locum cover. However, it is preferable that sufficient numbers of doctors, nurses and NCHDs are recruited to permanent posts to support the most efficient and effective delivery of services.