Seymour Crawford
Question:13 Mr. Crawford asked the Minister for Health his views on an EC directive on a 48-hour week for health care workers, including non-consultant hospital doctors; and if he will make a statement on the matter.
Ceisteanna — Questions. Oral Answers. - EC Directive on Working Week.
The proposed directive to which the Deputy refers is of general application and not specifically directed at health services. Ireland has been represented at negotiations on the proposed directive by the Department of Enterprise and Employment which has consulted with my Department on its implications for health service workers. The draft directive was discussed at a Social Affairs Council meeting on 1 June and political agreement was reached on a common position. It was agreed to exclude several groups of workers from the provisions of the directive. Among those excluded are doctors in training.
(Carlow-Kilkenny): I am appalled that doctors in training are excluded from the terms of the EC directive. Doctors in hospital training are treated like slaves. It is questionable whether patients can be helped by doctors who work such long hours. This exemption under the EC directive is outrageous. Will doctors have to work incredible hours each week?
There have been significant improvements in the working hours of non consultant hospital doctors in recent times. An agreement was reached with the Irish Medical Organisation in 1989 on a reduction of the average working week to 65 hours.
(Carlow-Kilkenny): That is still outrageous.
Until that time doctors were working up to 100 hours. In the United Kingdom an 80 hour week is the norm for doctors. Taking account of various forms of leave granted to NCHDs the average hours worked per week are 52. Having regard to the fact that doctors are undergoing training that number of hours is not totally unreasonable. This links in with a previous question regarding the training period for NCHDs.
Will the Minister agree that one of the most disturbing trends in the medical area is the level of litigation and the cost of medical indemnity insurance? Has the Minister or his Department carried out any study on the link between the duration of hours worked by health workers, the level of stress and level of litigious claims?
I am reluctant to answer that question as a specific question has been tabled on medical indemnity and insurance.
Would the Minister agree that the exemption in respect of hours which was politically negotiated under the EC Directive was sensible given the state of the health services here? Having regard to the consultation document on manpower services in hospitals, in the short to medium term it may be possible to reduce the hours worked by non consultant hospital doctors, but at present before any restructuring takes place it is politically correct to exempt medical services from the terms of the EC directive.
It is a priority to ensure adequate medical cover in each hospital. I would be reluctant to agree to anything that would immediately impact on the quality, cover and number of professionals available in our hospitals. Significant costs were involved in reducing the number of hours worked in 1989. That cost is borne annually in the health services. Any further reduction in the number of hours worked by NCHDs will have a cost implication as will any restructuring of the ratio between consultants and NCHDs. They will be significant cost factors on an ongoing basis and must be viewed in the context of the available resources in the health care area.
Would the Minister agree that it is desirable that stressful work should be carried out by doctors who are not over-stretched because of their working hours? The EC directive is being introduced because it is desirable to have a shorter working week. It is a shameful omission that the directive does not apply to health workers. Could this matter be resolved through a job-sharing scheme? There does not appear to be any job-sharing scheme for consultants. The profession, especially women consultants, have signalled that job-sharing would be a welcome development within the hospital service. The existing EC Directive provides that there should be a 48-hour working week limit for health care workers. Would the Minister consider job-sharing as a solution to the problem of long hours worked by health care workers?
The Deputy has made a number of points. I hope the directive also applies to politicians.
We do not work.
That would be a dramatic improvement compared to our present working hours. Doctors in training are excluded from the provision in the directive. The directive will apply to all other categories. If the 48-hour principle is applied across the board to non-consultant hospital doctors the cost factor involved must be considered. I would be willing to consider the issue of job-sharing. The issue relates not just to doctors but to nurses also. I am sure many Deputies have been approached by nurses who wish to work on a part-time basis. There appears to be some resistance to a job-sharing scheme in some areas of the health service, but I am addressing this issue.
By matrons.
The quality of care would be improved by people working hours which suited them under a job-sharing scheme. I would favour such a scheme.
(Carlow-Kilkenny): I accept a reduction from 100 hours a week to 65 is a great improvement. It is a case of lies and damn lies. I am not accusing the Minister of telling lies. Working 100 hours is absurd and 65 hours is just as indefensible. The doctors working those hours are treating patients who are at their lowest ebb and those patients should be treated by doctors who are relaxed and not under stress. I do not understand why doctors and the unions representing them agree to those hours of work.
In the United Kingdom an 80 hour week for health care workers is the norm. People assume that the United Kingdom has an advanced health service. Reduction in working hours might be desirable but there is a significant cost factor involved in providing such a reduction. Consideration must be given to balancing the priorities.
(Carlow-Kilkenny): That is a form of slave labour.
It is a training process and most people in training work longer hours than the recognised norm which applies to those who are qualified. The training period for doctors is a more crucial issue and consideration must be given to reducing that period so that people may become consultants at an earlier age and work shorter hours. I would favour a hospital system that is not only consultant led but consultant provided. I would like more consultants available on the wards to treat patients directly.