Vol. 505 No. 5
2 Ms McManus asked the Minister for Health and Children the outcome of the meeting of the Council of Ministers on 25 May 1999; if the matter of working hours for junior hospital doctors was discussed; the outcome of any discussions; the steps, if any, he will be taking to limit the hours these doctors may work; and if he will make a statement on the matter. [14081/99]
The Deputy will be aware that trainee doctors, along with several groups, were excluded from the provisions of the original working time directive adopted by the European Union in 1993. Following adoption of the 1993 directive, the European Commission embarked on a consultative exercise with the sectors concerned and the member states on how a broadly similar level of protection to that provided by the 1993 directive could be afforded to the excluded groups while taking account of the specific requirements of the industries and services concerned. In the case of doctors, this involved attempting to balance the need for reasonable working hours for doctors while recognising the 24 hour nature of hospital services and the need to guarantee continuity of care for patients.
In Ireland's case, we needed a framework which would allow us move from the present position of a maximum working week of 65 hours for junior doctors to the 48 hours contained in the 1993 directive. My Department has been concerned to achieve this in a manner which would not endanger patients and which would not throw the entire medical workforce career structure into chaos by recruiting large numbers of trainee doctors for whom there would be no reasonable prospect of securing career posts. The Deputy will be aware that the future structure of the hospital medical hierarchy is being examined by the Medical Manpower Forum.
The European Commission published its proposals for an amending directive to the 1993 directive in November 1998. The Commission's proposals have been the subject of discussion in a social questions working group under the aegis of the Labour and Social Affairs Council. A significant number of the member states felt the Commission's proposals were impractical and could not be implemented in the timescale proposed. The German Presidency then had to work on compromise proposals which might be acceptable to a majority of member states. These proposals involved a total transition period of 12 years with a gradual reduction in maximum weekly working hours to 48 hours over the period. The United Kingdom proposed a 13 year transition period to reach the objective. In the interests of securing unanimity at the Council, this proposal was accepted.
I must point out that we have progressively reduced hospital doctors' working hours over the years. The 65 hour week was introduced in 1989-90 at considerable cost resulting in the recruitment at the time of more than 400 additional doctors. The number of junior doctors has continued to grow since then. This growth has resulted in a serious imbalance between the number of these trainee posts and the number of consultant posts.
Additional information.I established the Medical Manpower Forum to address this and associated medical manpower issues. The forum is taking full account of the need to reduce working hours in its deliberations. However, we have to be realistic in how we approach this complex problem. I have no objection to doctors working a 48 hour week, but we have to have regard to where we are now. What we have sought from these negotiations is a practical framework to implement the 48 hour week. We now have a set of proposals which will allow us to reduce doctors' hours in an orderly and progressive fashion without jeopardising standards of patient care or damaging young doctors' reasonable career expectations.
I would have liked to have heard the remainder of the Minister's reply. Will the Minister accept that the decision by the Irish Government to effectively put this issue on the long finger at the Council of Ministers meeting has been a source of bitter disappointment, as described by the doctors themselves? While everybody understands and accepts that there has to be a lead-in period, such a lengthy period will cause risk to patient care that is unacceptable both to the public and to the doctors? In terms of the 65 hour week mentioned by the Minister, does he accept that many junior hospital doctors work more than 100 hours per week – I have heard of some working 130 hours per week – and to claim we are dealing with a 65 hour week is erroneous when one considers the position on the ground? Will the Minister comment on what is happening on the ground?
In relation to the specifics of the agreement, there is a lack of clarity about the definition of "working time" on-call. The way it is currently phrased in the agreement it is almost inoperable. Will the Minister indicate how he views the measurement of the time doctors work when they are on-call?
Since this decision was made, we have to be realistic about the way we approach this complex problem. I have no objection to doctors working a 48 hour week but we have to have regard to where we are now. What we have sought from these negotiations is a practical framework to implement the 48 hour week. We must ensure that we do not have a situation where we cannot meet the career expectations of trainee doctors because we have not properly dealt with the balance to which I referred in my reply. The issues are being addressed proactively by the Medical Manpower Forum in this jurisdiction, apart from the question of where the working time directive is going in the future. This problem has been with us for some time but the previous Administration did not put any effort into addressing it. We are doing that. In practical terms, under the forum framework we are seeking to help to address these issues. There is also the question of the definition of working time. The time spent on call is not counted as working time for the purposes of the directive. At present, Ireland includes time spent on call when calculating working time. However, this assumes that hospitals would be able to establish and maintain clear distinctions between normal working time and time spent on call. Mechanisms would also have to be established to measure time actually spent working when on call. This would be counted as working time.
On the manpower forum, when will we get specific recommendations for dealing with this issue? No one would argue with the Minister's statement that a lead-in time is necessary, however, there will have to be a lot of preparation. When can we expect recommendations?
What is the Minister doing concerning the intake into medical training schools to ensure that we have sufficient numbers to meet the requirements? In particular —
I must now call Question No. 3.
This is crazy.
