Sir, – In Sinéad O’Sullivan’s excellent analysis of the ongoing waste of public money, there was one forgivable understatement (Opinion, May 13th). The sheer magnitude of recruitment of healthcare staff from overseas as a rapidly increasing driver of costs in the health system is widely underappreciated. A clear indicator of just how lucrative healthcare recruitment has become is illustrated by the explosion of companies in the Irish market, many awarded specific contracts or preferred provider status by the HSE. Hospitals routinely engage in recruitment drives outside the EU, bringing nurses, radiographers, healthcare assistants and doctors to care for patients here. Recruitment companies have mushroomed, capitalising on our insatiable hunger for staff to replace our healthcare graduates who have left for more favourable working conditions.According to figures from the Nursing Midwifery Board of Ireland (NMBI), 3,717 Indian nurses registered in Ireland in 2024, compared with 1,569 Irish nurses in the same period. This reflects a 14 per cent year-on-year increase in new nurse and midwife registrations. India leads the countries generating new registrations, followed by the Philippines, Ghana and the UK. It is a similar picture for doctors, with 53.8 per cent of newly registered doctors coming from outside the EU, largely from Pakistan and Sudan and a 60 per cent growth in the register overall. Patients would be lost without these doctors and nurses who make an important contribution to our growing workforce needs. However, each healthcare worker brought into this country through a recruitment firm costs the taxpayer a substantial fee. That fee could be avoided by valuing our graduates enough to address endemic excessive working hours, poor career progression and dysfunctional workplace cultures. It is disappointing but not surprising that the newly recruited foreign healthcare staff often move on to Canada or Australia after a few years of the same experience, resulting in a further round of recruitment fees.For the healthcare staff who do remain, the endless cycling of staff requiring induction and support is exhausting and demoralising.With so much commercial interest in recruitment, any rational person would ask why there is so little appetite for reducing the international merry-go-round. – Yours, etc,Dr SUZANNE CROWE,Consultant in paediatric intensive care,Ranelagh, Dublin 6.