I want to raise with the Taoiseach today the crisis in healthcare staff recruitment, specifically the crisis in recruitment of hospital doctors, and the serious implications for patient safety and the future of the health service.

Currently there are 450 vacant consultant posts. Even if all of these posts were filled we would still have the lowest number of consultants per capita in the OECD. Downstream, there are also more serious problems that need to be addressed very soon.

Ireland trains high numbers of doctors at very high cost. The vast majority of these doctors emigrate. In 2014, for example, there were 684 medical graduates, 627 of whom left Ireland. In 2017, 700 medical graduates who left the country. A key contributor to the deplorable waiting lists is the shortage of hospital doctors. Nearly 1 million people are waiting on hospital care of one kind or another. In the last few days we heard that 30,000 women are waiting for gynaecological hospital services.

It is also a major contributor to the dysfunction within our health service. There are many reasons why Ireland cannot hold on to its hospital doctors. The unmanageable workloads and the inevitability of burnout is a key factor for a lot of doctors. There is also the hierarchical nature of the career structure for consultants and the lack of career prospects. Pay is undoubtedly an issue and the two-tier health system, as in many other careers, is hugely damaging with regard to hospital doctors and should be addressed urgently. The convoluted two-tier recruitment system in operation is also inexplicable. There is a lack of reform of the health service. Hospitals are stressful places for doctors to work and there is no indication that the Government is serious about a reform programme.

Getting timely access to care has a significant bearing on this because it means there are increasing difficulties for patients. This is also depressing for doctors. Knowing that delays have resulted in conditions becoming more serious for patients, knowing that treatment is less successful due to those delays and knowing that the system is failing patients, with doctors constantly having to apologise, is very stressful.

On top of all these issues is the recent HSE report that has pointed to serious problems around the importation of doctors with many doctors coming from developing countries, with questionable practices in relation to whether that is ethical or not, issues about the qualifications of those doctors, inadequate clinical oversight of those doctors and the transient nature of those foreign doctors, who are basically propping up our health system currently. We know that 50% of the non-consultant doctors are now called "non-training scheme doctors". This is a new category. Non-training scheme doctors are mainly foreign doctors and in some hospitals 80% of the non-consultant hospital doctors fall into this category. I call on the Taoiseach to publish that report and let the House know what action the Government will take on the crisis in the recruitment of hospital doctors.

I am sure the Minister for Health, Deputy Harris, will publish that report in proper order. The Government very much acknowledges that we have real difficulties in our health service when it comes to recruiting and retaining staff, not just doctors but also nurses, midwives, therapists and others. Notwithstanding that, it is not acknowledged, and it should be acknowledged, that there are more people working in our health service than ever before. There are 115,000 people now working in our public health service, which is 10,000 more than three years ago. The impression is sometimes created that more staff are leaving than are joining but that is not the case. It is not the case for the health service in general and it is not the case when it comes to doctors. There is a record number of doctors now working in our public health service. We have never had more doctors working in our public health service than today and there have never been more doctors registered in Ireland. The Deputy just needs to check the register of the Medical Council if she does not believe me. This is the true picture. Yes there is a real problem around recruitment and retention but never were more people working in the health service and never had we more doctors working in Ireland or on the Medical Council register.

The Deputy referred to 450 consultant post vacancies but this figure is not verified. The Public Service Pay Commission examined that and was not able to verify the correct, exact number of consultant vacancies. Often when the term "vacancy" is used the impression is created that nobody is doing the job but very often there is and the role is filled through a temp or locum doctor, which in some cases are long-term temps or locums. Last week I checked on publicjobs.ie and saw there were only 20 vacancies being advertised. I appreciate that the voluntary hospitals advertise positions in a different way but there are only 20 vacancies advertised. It begs the question whether there are jobs that historically have not been filled and will never be filled, and whether we need to take a more comprehensive look at what positions will actually attract staff and applications. I am aware of many registrars and doctors who are waiting for a job to be advertised. They are very keen to work in a particular area or hospital but the advertised jobs are in branches of medicine they do not want to be in, or for places they do not want to work. It is difficult to grasp that nettle but we do need to grasp it and advertise positions that will get applicants, rather than advertising for positions that, sadly, we know will not.

Deputy Shortall spoke about medical graduates emigrating. It is important to bear in mind that a very large number of medical students in Ireland are from overseas. When they emigrate they are actually emigrating back to the country from which they came in the first place. That was always their intention. A very large number of Irish medical graduates who were born and brought up in Ireland leave and come back. Not as many come back as used to but going away for experience is not a bad thing. It is a good thing.

Reference was also made to non-training scheme doctors. It is true there are a lot of doctors working in peripheral hospitals, what were called county hospitals, throughout the State who are not in training schemes. They are not on training schemes because the medical colleges no longer recognise those hospitals as being training or teaching hospitals. In the past we were able to attract people to work in those hospitals from Ireland and overseas because it counted towards their training. Medicine has moved on, however, and those hospitals are no longer recognised for training purposes and may never be again. We must also face up to this. It is not an easy one.

The Taoiseach seems to be in denial about the facts of the matter. Ireland has the lowest number of consultants per capita but is the highest exporter of doctors. We are the biggest importer of foreign doctors in the world and there are huge problems associated with this. A number of those problems have been identified in this high-level HSE report, access to which we have had only through leaks to The Sunday Business Post and The Irish Times. I put it to the Taoiseach that it is undeniable there are serious problems with recruitment in the health service. There is a report with a detailed analysis of those problems. The report has been with the Government since last January. Why is the Government not publishing the report? Will the Taoiseach give a commitment today to publish this report as a matter of urgency so these serious problems can be addressed?

The Deputy mentioned the HSE report. It has not gone to Government yet so it could be difficult for me to answer that question as it is not a Government report and has not gone to Government yet.

That is Jesuitical.

I will certainly make inquiries about it. I do not see any reason it cannot be published, although there may be a reason I am not aware of as it is not a Government report.

Will the Taoiseach commit to publishing it this week?

I cannot make a commitment on behalf of the Government to publish a report that is not a Government report. I will have to find out if there is a reason it has not been published yet.

The Government is in charge of the HSE.

Order, please.

To answer the Deputy's question further, I think she accused me of being in denial about the facts. What we both did is this: the Deputy gave some facts which are true and I gave other facts that are also true.

This is Trumpian.

I would ask Deputy Shortall to bear in mind that there is a bigger picture and, when we take her facts and my facts, we get to the truth. The Deputy is only talking about one set of facts.