When I took this position last year, I naively asked if we could use the word ‘crisis’ less frequently in our press releases. I felt it was becoming a tired cliché, losing all meaning from over-use. However, a year on, I have a different view. When there are 602 patients waiting on trolleys for a hospital bed, does the word crisis even go far enough? Does it convey the misery and suffering of patients waiting on trolleys for inpatient care? Perhaps we should use words like disaster or catastrophe. However, all three of these words imply an acute moment in time. In the Irish health service, this situation has become the constant and the norm. And it needs to change.

To achieve this change, the IMO has consistently called for adequate funding of our public health service. Capital investment has remained static at 5% of overall funding for the last forty years. This is clearly inadequate and has prevented our health service from expanding to meet the demands of a growing population which now stands at over 4.7 million people. We simply do not have the physical capacity in the secondary or primary care settings to meet the demand for medical services. A major investment programme in the public system is required. However, in some cases, doctors and others have not helped the progression of much-needed infrastructure projects. Ongoing turf wars over major developments like the National Children’s Hospital and National Maternity Hospital do not help our patients. Women and children deserve modern 21^st century healthcare facilities. Doctors must put aside their differences and unite behind these projects.

One change that has taken place since last year’s AGM is a change of government, and the advent of the Oireachtas Committee on the Future of Healthcare. While the idea of a ten-year strategy for the development of health services in Ireland is sound, we are concerned at some media reports on the work of the committee. The announcement in January that the Committee would not be costing its recommendations did not bode well. The IMO supports the introduction of universal healthcare. However, the reported proposal to roll-out free GP care for all in the next five years is unrealistic and likely unachievable, based on current staffing and funding in the primary care setting. Equally, legislating to oblige hospitals to operate on patients within twelve weeks is impractical. It cannot happen unless there is an explosion in theatre capacity in this country. Even if all operating theatres were opened and fully staffed next week, it could not happen. There simply isn’t the physical space in operating theatres or surgical wards to cater for all the patients who would require surgery in this time-frame. If hospitals are fined or punished for failing to meet this target, it will have a negative impact on the whole hospital. This kind of target-driven culture will not help patients, and could ultimately harm them, as occurred in Mid-Staffordshire, where managers focussed on targets and numbers instead of patient care. The Francis report found that this resulted in the death of patients. It is disappointing that a promising idea has descended into empty ideological political rhetoric. The IMO is always open to a meaningful, realistic discussion on provision of healthcare in this country, and this was reflected in our submission to the Committee. We called for an open debate on the best funding model for our health services, and it will be disappointing if the Committee on the Future of Healthcare does not properly address the issue of funding.

Another seemingly unchanging feature of the Irish healthcare landscape are disputes between NCHDs and their employer. The last year was no different but thankfully industrial action was avoided over the Living-Out Allowance dispute. It gave me great pleasure to see the IMO achieve a pay rise for over 4,000 doctors, effective from 1^st July. I hope that in future the HSE will live up to Director General Tony O’Brien’s call for employee disputes to be resolved through the usual industrial relations channels. The IMO had attempted to do this repeatedly over years to resolve the Living-Out Allowance issue. It was only through the threat of court action that this dispute was settled. That is no way to foster good relations between doctors and the employer. I look forward to the HSE changing its approach in the coming years. The next step will be to enter meaningful talks over training supports for NCHDs, as agreed earlier this year. I am hopeful this will begin a more positive relationship between ourselves and the HSE, and that we can work together to make the Irish health service a more attractive place to work for doctors.

Last year I spoke about my personal experience with workplace bullying. Sadly, I have learned this is not an isolated experience as I have been contacted throughout the year by other doctors who have told me about their own problems with bullying and harassment. This only strengthened my resolve to address this issue. This culminated this month in the signing of The Respect Charter by the IMO, The HSE, and the Forum of Irish Postgraduate Medical Training Bodies. I admire the active and positive support that HSE HR Director, Rosarii Mannion, has shown for this initiative. This is a good example of how the IMO and the employer can work together to address workplace concerns. Our fight does not stop here: we will continue to work with the HSE and the training bodies to change the culture, share knowledge and develop new supports for doctors who experience bullying and harassment during their career.

Another culture shift that has been to the forefront of my mind this year has been gender equality in Irish medicine. The IMO survey on these issues had more responses than any survey we have conducted in the last ten years, and the results will make for interesting reading when they are released later this year. I am proud to be part of an organisation that has led the way with female leadership in Irish medicine, appointing our first female president in 2002, the late Dr Kate Ganter, ahead of other prominent medical bodies. It will be a privilege to hand over the chain of office to my successor, Dr Anne Hogan, who will no doubt continue this line of strong women leaders in Irish medicine.

I asked at the start of this speech if anything had changed in the last twelve months. Change is a process, and I am proud of how we have contributed to that process during my time as President. In the words of Barack Obama, “believing that change is possible is not the same as being naïve. Go into service with your eyes wide open, for change will not come easily”. IMO members under the leadership of Dr Anne Hogan will continue to believe that change is possible, and will continue to make that belief a reality.