Dáil Éireann debate -
Thursday, 11 May 2000

Vol. 519 No. 1

Private Members' Business. - Non-Consultant Hospital Doctors: Motion (Resumed).

The following motion was moved by Deputy Shatter on 10 May, 2000.

"That Dáil Éireann:

–deploring the failure of the Government to make reasonable proposals to resolve the current dispute with non-consultant hospital doctors,

–alarmed at the continuing deterioration in our health service at a time of unprecedented economic prosperity,

–acknowledging that the hours presently worked by non-consultant hospital doctors detrimentally impact on doctors' health and undermine their ability to provide proper patient care,

–concerned at the inability of the Health Service Employers Agency to constructively address and resolve industrial relations issues within the health service as evidenced by its failure after six months of negotiations to make any substantive proposal to resolve issues in dispute relating to non-consultant hospital doctors,

–conscious of the serious damage to the health service that will result from strike action by non-consultant hospital doctors and the effect of such a strike on patients resulting in the further escalation of the in-patient hospital waiting lists,

–acknowledging the crucial role played by non-consultant hospital doctors in our hospitals,

–agreeing that the hours presently worked by non-consultant hospital doctors are totally unacceptable and are inadequately remunerated,

–deploring the fact that some non-consultant hospital doctors have been forced to take legal action to secure overtime payments due to them and that substantial arrears of remuneration for overtime hours. worked are presently payable to non-consultant hospital doctors,

–noting that 98% of non-consultant hospital doctors voted for industrial action for higher overtime rates, shorter working hours and better staffing ratios,

condemns the failure of the Minister for Health and Children to intervene at an early stage to facilitate the reasonable resolution of the issues in dispute, and calls on the Minister for Health and Children to immediately enter into substantive negotiations with the Irish Medical Organisation in order to resolve the current dispute and to avoid a damaging strike occurring."

Debate resumed on amendment No. 1:

To delete all words after "That" and substitute the following:

Dáil Éireann:

–endorses the Government's handling of the present dispute with non-consultant hospital doctors;

–urges the Irish Medical Organisation to agree to third party mediation to resolve outstanding issues;

–acknowledges additional resources which have been made available for improvements in the health service;

–recognises that the Government is committed to implementing structural changes in the medical workforce in hospitals;

having regard to the negative impact the proposed strike would have on patient care and the offer from health service employers to independent third party mediation, calls on the Irish Medical Organisation to call off the threatened strike and to pursue their case through the normal industrial relations mechanisms.

–(Minister for Health and Children).

Mr. M. Higgins

I am pleased to have an opportunity to speak on this issue which is of immense importance in creating a proper health service. My party colleague, Deputy McManus, spoke yesterday evening about how a proper adequate health service could be put in place. In the time available to me, I will direct my comments to the dispute itself.

The position of non-consultant hospital doctors has for many years been little less than a scandal. It is hard to read in the year 2000 of conditions where a non-consultant hospital doctor, having finished a period in university and training in a hospital, can be in a position of not being able to secure a basic roster for his or her time and service. When one considers the conditions that prevail, a few matters are very clear. First, it is not possible to address this problem without looking at the inadequacy of consultant posts. It is not possible to address the issue without accepting that a career structure must be put in place to enable people to move from NCHD status to consultants. It is not possible to solve this issue on the basis that it is a dispute that has arisen recently or one that can be solved as a short-term labour negotiations problem. The two sides to the dispute, for example, on the health employers side, are not in a position to negotiate on the structure on the basis of the dissatisfaction in the hospitals at present.

I read with great care the Minister's speech and there is immense dissatisfaction and anger at the description of non-consultant hospital doctors not being fully trained. They clearly point out, and rightly so, that after the longest period of university lectures, exposure to health training and in-hospital training, they are fully qualified doctors and hope to be on their way to specialist qualification as fully accepted and recognised specialists. The idea that one can lean back and take advantage of what could be described as a kind of class system whereby people who might have aspired to becoming consultants must make themselves available under the most inappropriate conditions is simply unacceptable. It is one of the most disgraceful marks of the European Union, and far more indicative of right-wing thinking within it which wants to destroy the social fabric of employment across the board, that there has been this enormously long waiting period for the implementation of the directive in relation to working time. While there may have been a need in the beginning to consider the supply of essential medical services because of its importance to the public, there is no justification for introducing a period of 13 years, adjusting it to nine years and including no interim points when people might see their hours reduced in the short term. It is impossible to ask people to accept a regime of compulsory, non-rewarded, non-recognised overtime. During this time doctors are not off duty but neither are they being remunerated. The Department of Education and Science could play a part in the resolution of this dispute, by providing additional resources for an improved structure which would enable people to build a professional career from the time of their early recruitment as non-consultant hospital doctors.

This dispute, which has been building up over many years, is evidence of a complete erosion of trust. Junior doctors are now being asked to enter into negotiations on one half of the agenda, with the main structural elements left to one side, while at the same time realising that the 1997 contract has not been implemented. If the Minister wishes to enter meaningful talks on any aspect of the problem, the provisions of the 1997 contract should be fully implemented as a gesture of goodwill. The undertakings given on rostering must also be implemented. The Department of Health and Children was to issue a directive to the hospitals in regard to rostering in order that people would know when they would work. My information from people working in the area is that that is not happening in the majority of cases.

How can the Minister state that this dispute can be resolved within the framework of the most recent agreement when the terms of the previous agreements have not been implemented? If the Minister is to be taken seriously at all, he must clear the decks in regard to previous undertakings and deliver on them. He must also make a fundamental commitment to allocate resources, beyond the terms of any negotiations which may occur, to improve structures, increase the number of posts and provide a career structure for transition from non-consultant hospital doctor to consultant status.

The Minister stated that he had taken the most benign interpretation possible of the outcome of the EU negotiations on the nine year issue. When we previously had a 13 year proposal, there were also proposals for stage points at which there would be a reduction in hours. If the Minister now accepts a nine year proposal instead of a 13 year one and takes away these stage points, he will extend the period of time rather than reduce it. The Minister may wish to clarify his position on this matter. What could appear to be an improvement would make the situation worse.

I urge the Government to stop talking about the "gross cost" of the health service. We need a first class health service which will be available to all our citizens. We have real difficulties in recruitment at every level of the health service. Many people are leaving university at an early stage for highly remunerated positions. Students studying medicine make a professional commitment to stay in college longer than others and they then progress to a system which in my time, 30 years ago, displayed more of the characteristics of a caste system than a health professional training system. That must end.

The only way to bring the non-consultant hospital doctors on side is to agree to implement the terms of the 1997 agenda prior to entering into negotiations. Any entry into negotiations will be an acceptance that only part of the problem is being addressed. Talks must open immediately in regard to putting in place a career structure for junior hospital doctors.

The Medical Manpower Forum was established two years ago but has not made a single significant proposal in regard to the structures I have described. How are junior hospital doctors to enter into negotiations as if their dispute was just an ordinary one when the most basic entitlements to time off, knowing what time one is working, what one's career structure is, what proposals for reform are being made and what funding will be provided to implement those are denied them? This is not a little dispute which can be resolved through some kind of administrative adjustment. It has been ripening over a long time and the non-consultant hospital doctors deserve to be taken seriously and to have their dispute resolved.

Mr. P. Carey

I wish to share time with Deputies Coughlan, Ardagh, Fleming and Michael Moynihan.

An Ceann Comhairle

Is that agreed? Agreed.

Mr. P. Carey

This dispute did not arise either today or yesterday. Deputy Higgins is correct in saying that it has been one of the longest festering disputes in the medical services. I have enormous personal sympathy for the plight of non-consultant hospital doctors. Those of us who have been in hospital have seen the contribution made by junior hospital doctors. However, the debate which was initiated last night and which is continuing this morning will not resolve the situation.

I compliment the Minister who, in his current and previous positions, has developed a record for conciliation, bringing issues to a head and resolving them. We have a very refined and sophisticated mechanism for resolution of disputes. At the risk of inflaming passions, I suggest that the IMO should enter into negotiations with the third party mediation service as its concerns would be adequately addressed there.

There is no doubt that this is an emotive issue. Long training periods, long working hours and unsatisfactory working conditions are sources of concern. There would be merit in refining the directive on working time but that would have implications for the funding of the health service. The Government has provided significant additional resources to the health service in the current year. This issue will not be resolved overnight or as a result of this debate.

A valid case could be made for the development of a career structure for non-consultant hospital doctors which would result in the establishment of a level between the non-consultant and consultant grades. That should be seriously considered. At a time when we need to retain as many professionals as possible in the health service, we must provide incentives through improved conditions, additional remuneration etc. We have the best and brightest doctors training in Ireland and working in our health service and we must keep them.

I am concerned about the management of the health service. There seems to be an attitude that issues will resolve themselves in due course. That is not good enough. I was quite taken aback when I discovered that some of the agreements entered into following the nurses' dispute have not been implemented in certain health board areas. That is not good and does not help in promoting good relations.

We must examine this in a comprehensive way, develop a package of proposals which will satisfy health managers and doctors, examine the career structure for NCHDs and look at the Medical Manpower Forum and its deliberations. With additional resources being made available by the Government and with goodwill on all sides the dispute can be resolved to everybody's satisfaction. We must remember that patient care is also important. The welfare and career prospects of non-consultant hospital doctors is important, but so too is patient care.

Mr. Ardagh

The best way of getting up to speed on a subject is to speak on it in the Dáil. I have great sympathy and respect for the hard work done by junior doctors. The fact that they are rostered for 65 hours and often work longer periods must be addressed. There is also a need to provide opportunities for advancement and further education which currently do not exist.

Deputy Michael Higgins said that up to recently doctors resulted from the caste system. If one's parents were doctors or had lots of money one could spend ten years studying medicine trying to get through the examinations. It is different nowadays as we have the best and brightest – people with between 500 and 600 points – getting first or second class honours degrees. There are very few doctors who are not of the highest intellectual calibre and the idea of the old time doctor is no more, which is a pity to some extent as I know many children of doctors who are passionate about giving medical service to patients. They know what it takes and it is unfortunate that in the current system many of these people, who would make excellent family doctors, are effectively barred from becoming doctors.

Junior doctors owe something in repayment for the time, effort and money which society has invested in their education, on the basis that those doctors will achieve great wealth and riches in their more mature years, as is normally the case.

Nobody wants to be treated by a tired, disen chanted doctor who feels they are being abused by the system. There is an obvious need to address the untenable situation which currently applies. As has been mentioned by a number of speakers, the Department of Health and Children is already developing a number of initiatives involving NCHDs with the Health Services Employers Agency and the Irish Medical Organisation. The first is the review of the 1997 NCHD contract. A clause in that agreement specified that the contract would be reviewed after two years. In terms of that contract it is a joke to talk about a standard working week of 39 hours given the number of hours NCHDs are expected to work, particularly in the busier teaching hospitals in the Dublin area where the intensity of activity is such that there is very little time for doctors to be on call. Rather they are asked to work not only the standard 39 hour week, but are rostered for 65 hours and in addition are under pressure from consultants to see patients, often working unrostered time which is effectively unpaid. This is unacceptable.

Over time the EU directive will reduce the number of hours which a NCHD can work, but the timescale is not acceptable to NCHDs or to the majority of the population. By 2009, when many of us will have retired, junior doctors will have to work 48 hours. By 2004 the maximum number of hours will be 58 hours, but there is no way a person working 58 hours can give the full energy and clarity of mind necessary when dealing with sick people whose lives depend on the actions of these doctors.

Last month a study was initiated, which is to be completed by June 2000, in the context of preparing for implementation of the directive. It is a basis on which further negotiations can be entered into with the IMO on behalf of the NCHDs, and I hope it will be a basis for helping to reduce the number of hours to a reasonable level.

The much talked about Medical Manpower Forum is hugely necessary. As vice-chairman of St. James's Hospital I am currently part of an interview panel for the appointment of a consultant in a particular speciality. The quality of the candidates for that job is phenomenal. They all have higher degrees, fellowships and fellowships in surgical specialities. It is well nigh impossible for a NCHD who is working 65 hours per week to achieve these qualifications. There must be change and an opportunity for junior doctors to attain the qualifications necessary to become a consultant.

Currently one is either an indian or a chief, but there must be a continuum where qualifications of junior doctors are recognised on a step by step basis. The difference between a consultant and a hospital doctor is the difference between chalk and cheese. This must change and there should be a continuum. This will necessitate the putting in place of different grades while hospital doctors will have to be given time to further their education so they can achieve the levels of expertise necessary so patients can be looked after with respect and dignity.

Ms Coughlan

Given the short time available, I wish to avert to one or two issues which encompass the entire problem we are debating. Regardless of our political persuasions Members are supportive of the non-consultant hospital doctors. We are aware of the problems in the health service which have been present for years. It is only in recent years that they have reached boiling point. We must assess why this is so. Perhaps over the years bad practice was adopted in the health services whereby, as in the case of the legal and other professions, people accepted the way things were done but when they were appointed as consultants they became intolerant of the problems faced by junior doctors even though they were acutely aware that they were still prevalent.

The main issue, which is that the number of hours worked by NCHDs is unacceptable, must be addressed. An agreement was reached in 1997 whereby they were to work an average of 65 hours per week. Junior doctors and management representatives have informed me that this arrangement was arrived at between three parties, the local management, consultants and NCHDs. There was an agreement that rosters would not be changed and additional hours would not be provided unless everyone agreed to them. However, because people were busy and did not have time to get organised, arrangements were made in which the three parties were not necessarily involved. This is the crux of the issue and it must be revisited. I am pleased the Minister stated categorically that the current contracts and outstanding difficulties will be considered in the discussions with the LRC.

The NCHDs have a justifiable case and the day of the Florence Nightingale syndrome is gone. People expect to be paid for their work and if they work over and above what is agreed in their contracts they expect to be remunerated. It is terrible that some doctors have had to take action for payments to be made to them. That has led to a terrible problem. The ethos of medicine has changed and there is friction between local management and doctors. I support the concerns expressed by the NCHDs and it is important in the public interest that contracts are revisited and bad practice is addressed. If people are owed money, they should be paid.

There are a number of other important issues, one of which is training. In the UK training is part and parcel of a contract and is protected therein. We must examine the question of training in the context of the review of hospital practice which is under way. Training is an element of junior doctors' contracts. If they are not able to undertake the training, then there is a serious problem. Given the strain on the system doctors are often appointed to training posts and, unfortunately, they are used to fill manpower gaps. If training can be ring fenced in contracts, many of the concerns which have been raised can be addressed.

It is also difficult to recruit locums and there are many reasons for their non-availability. In Letterkenny General Hospital many doctors cannot obtain locums not only because of the overall national problem whereby locums feel their conditions are poor but in peripheral areas hospitals such as that in Letterkenny find it more and more difficult not only to recruit locums but also to attract junior doctors. It is serious problem which will be exacerbated in the near future given that the Medical Council has rightly introduced new examinations and procedures for NCHDs, many of whom are non-nationals. There will be serious difficulties unless that matter is also addressed. There will also be serious manpower problems and as a consequence there will be even more stresses and strains on the system.

Confidence is being eroded and that is a terrible reflection on the fabulous commitment to patient care made by these people. It is in the public interest that this dispute should be addressed as quickly and as comprehensively as possible. This debate is only the tip of the iceberg regarding many of the issues that arise on a day to day basis between local management and junior doctor about which we are not aware. I urge the IMO to enter into negotiations under the umbrella of the LRC. The Minister has made a commitment to include all issues in these negotiations. Despite the lack of confidence and bad feeling between both sides, there should be some manoeuvrability to allow the issues, with which all of us empathise, to be addressed as quickly as possible in the context of the IR mechanisms that are available. I urge the IMO to enter into constructive negotiations on behalf of the NCHDs. I agree that the issue of non-payment of unrostered overtime, in particular, must be addressed in any negotiations.

Mr. M. Moynihan

I welcome the opportunity to contribute to the debate. As public representatives and ordinary citizens we have a certain amount of interaction with the health service through visiting family members or friends in hospitals. All of us have witnessed the work rate of NCHDs. Few people have anything but sympathy for them. They have decide to escalate this dispute and I appeal to them to revisit their claim and make sure everything is done to ensure a strike does not go ahead next week.

The Government is committed to resolving the dispute as fairly and equitably as possible and to include all interested parties in the negotiations. Past agreements between local management and NCHDs involved a working week averaging 65 and 58 hours per week. Our health service is expanding and expectations in regard to it are huge. Minor health problems which were addressed at GP level previously are now being treated in accident and emergency wards and elsewhere which has led to the public health service being almost in a state of collapse. It is not because of inadequate funding because since 1997 the Government has allocated large sums of money to the health service. The money is going in but we are not getting results for one reason or another. Funding is one issue, but perhaps there should be a critical analysis of management and the way money is spent.

Consultants are the top professionals at work in hospitals, particularly public hospitals. These people are excellent at their jobs and whether they have arrived at the positions they occupy through privilege or on foot of their intelligence, they must be applauded for the work they do. However, non-consultant doctors are slotted into the system and given little scope to develop their own initiative. One of the reasons they are taking the route of industrial action is the lack of opportunities to advance their professional careers. People in all walks of life, particularly non-consultant hospital doctors, need to be encouraged and shown that prospects for their future careers are good.

My main point is that we realise that non-consultant hospital doctors have a legitimate grievance and we know that they have been under severe pressure. However, the Minister for Health and Children, Deputy Martin, has asked them to bring that grievance to the Labour Relations Commission. Given the industrial relations machinery which is in place, there should be no need for a complete stand-off in this dispute. Negotiations will have to commence at some stage and the dispute will have to be resolved.

Mr. Fleming

I thank my colleagues for sharing time. I support the Government's handling of the current dispute with non-consultant doctors. I urge the Irish Medical Organisation to agree to third party mediation to resolve the outstanding issues. I acknowledge the additional resources that have been made available to the health services by the Government and the Minister, in particular, and I recognise that the Government is committed to implementing structural changes in the medical workforce in hospitals.

Everyone accepts that non-consultant doctors have a legitimate grievance. However, I urge them not to proceed with their industrial action on Wednesday, 17 May. I ask them to take their grievance to the Labour Relations Commission because they will be obliged to do so in order to resolve the dispute, regardless of whether they take industrial action next Wednesday or on some subsequent date. It will be better if they go before the commission sooner rather than later. There is no need for them to make the point that they possess industrial muscle because everyone accepts that this is the case.

No one needs to inform the Government about the important role played by health service workers. It is a fact that health services cannot be delivered without these people. We do not need them to prove their point; that point is well made. It would be a major development if we could leapfrog the next step, namely, the proposed industrial action, and proceed to the negotiations.

The Minister indicated that he is prepared to consider all major issues in respect of the difficulties experienced by non-consultant hospital doctors and that is a welcome development. One issue in respect of which everyone can empathise with non-consultant doctors is the long hours they had to work in the past and will continue to work for a number of years to come. I am glad the Minister has proposed that within nine years all non-consultant doctors will only be obliged to work a 48 hour week. That development is far in the future but in the negotiations on this matter at European level other countries proposed that it should not take place for at least 13 years. The Minister has been very brave in proposing a shorter timescale, even though we know that this remains overly long. Under the circumstances, however, it is the best that can be achieved.

I wish to highlight the fact that over £4 billion is being invested in the health service on an annual basis. That means that £12 million is being spent in this area per day. Since we entered Government we have invested an additional £1.5 billion per annum in the health service. I am pleased the national development plan contains capital spending of £2 billion on health. As far as I am aware, this is the first occasion on which health spending has been included in a national development plan. One result of that spending is that the hospital in Portlaoise will gain a new wing and I look forward to the Minister coming to turn the sod on that new development during the summer.

Spending money on the health service is not sufficient. I do not believe we are getting value for money and, in my opinion, the resources in the health services are not being allocated properly. However, I commend the Minister for the approach he has taken in this matter.

Mr. Neville

I wish to share time with Deputies Clune, Stanton, John Browne, Crawford, Boylan and Allen.

An Ceann Comhairle

Is that agreed? Agreed.

Mr. Neville

It is deplorable that the Government has failed to present reasonable proposals to resolve the dispute with non-consultant hospital doctors which will put the lives of those who are most vulnerable at risk. The number of hours these doctors work are Dickensian and are a relic of a time when workers were cruelly exploited and when children were sent into factories to work 12 hours or more per day. The Minister must accept that working two weeks in one must interfere with a doctor's ability to perform in his or her profession and inhibit his or her ability to provide proper patient care.

The Health Services Employers' Agency has failed to deal with the industrial relations problems in the health service and has been negligent or incompetent or both in its endeavours to resolve the issues in respect of which non-consultant hospital doctors are in dispute. What other groups have been forced to take legal action to obtain the rightful overtime payments due to their members? The Minister for Health and Children must intervene immediately to ensure that this dispute does not escalate, that positions do not harden and, consequently, that the resolution of the dispute does not become more difficult.

The Government should have learned from the nurses' dispute last October when it failed to enter negotiations with the nursing unions and was responsible for a bitter dispute which saw nurses marching in their thousands through the streets of Dublin. The concerns of non-consultant doctors do not merely relate to their conditions of employment; they also relate to their frustration about the service given to patients in public hospitals. They are concerned about the impact on their health of working 70, 80 or even 100 hours per week, the impairment of their ability to make clinical judgments and the fact that the stress they must endure, which is created by their conditions of employment, puts patients at risk.

The pay currently received by junior doctors for work in excess of 48 hours in any week is equal to half the basic hourly rate paid to them for normal work. There is no other area of the public service which would accept half-time pay for excessive overtime.

The health service in our general hospitals is under unacceptable pressure. Apart from the unacceptable, cruel and inhuman waiting lists for admittance to elective surgery, accident and emergency departments must be the most inefficient of any departments that interface with the public. If accident and emergency services were provided by private sector companies, those companies would have entered liquidation many years ago. Why must patients and their families wait for hours on end for admission to hospital? No one paying for this level of service by way of taxation should be obliged to endure such discomfort.

At Limerick Regional Hospital patients are obliged to wait for hours on end, under stress and pressure, to be seen by a doctor in the accident and emergency department. On Friday, 11 December 1999, an 80 year old woman fell down the stairs in her home, was injured and, suffering severe pain, was admitted to the hospital at 1 a.m. Despite the fact that she was under severe stress, elderly and injured, she was discharged at 4 a.m. Her family informed me that on her return, she spent hours in an extreme state of stress and suffering. It is not fair to treat an elderly person in this way. I get the feeling that elderly people are almost dispensable where hospitals are concerned. The response of the Mid Western Health Board to me on that case was as follows:

It is planned to develop an observation unit attached to the emergency department to allow for the accommodation of patients in a position similar to Ms X.

This sort of treatment is not good enough. I now want to cite the case of a ten-year old boy who, in March this year, broke his arm in a sporting accident. He arrived at the accident and emergency service of the regional hospital on Monday, 20 March at 4.25 p.m., accompanied by his father. At 9.30 p.m. his father consulted the hospital staff who informed him that it would take another four hours before the child could be seen. That would have been more than nine hours after the child arrived at the hospital. As the father had to be at work at midnight, he took the child home in severe pain. The child returned with his father to the hospital the following day at 10.15 a.m. He had still not been seen at 2.30 p.m. that day. At that stage the father requested the note from the GP to the hospital and took his child to St. John's Private Hospital in Limerick. There the boy was seen and dealt with within one and a half hours. Surely, the service to the taxpayer by the health system, as demonstrated in this case, is nothing short of a disgrace and a scandal.

I am extremely concerned about the discharge of suicidal patients from psychiatric treatment units. There appears to be no policy with regard to those who are in danger of committing suicide after leaving such hospitals. Research shows that the magnitude of risk of dying by suicide during the four weeks following discharge from a psychiatric hospital increases between 100 and 200 times. The risk of those who are suicidal is surely much greater than that of a normal person. I have heard from families who are frightened for the safety of a loved one who is discharged from hospital, sometimes without any consultation with the family. In several cases the families concerns have proved to be too true, and the patient has gone on to die tragically by suicide after release from hospital. There is a "hands up" approach by the health services whose attitude seems to be that they can do nothing if a person is determined to take his own life. This inhumane attitude is an indictment of our support system and typical of the general attitude to those who suffer from psychiatric illness.

In his contribution yesterday, the Minister informed the House that the Health Service Employers Agency had indicated that it is prepared to honour in full its commitment regarding the contract with non-consultant medical staff. Why has it taken the threat of industrial action for the HSEA to state that it will honour the current 1997 contract? As a result of growing unrest in 1999, at a meeting with the IMO in April and again in June last year, the HSEA was asked to issue a directive to individual hospitals urging them to honour the provisions of the 1997 contract, yet they refused to do so.

An Leas-Cheann Comhairle

For the benefit of the House the Ceann Comhairle has left a list of Members who will contribute to the debate. They will be called on the basis of their arrival in the House. For the benefit of Members, they are: Deputies Crawford, Stanton, Boylan, Clune and Browne (Carlow-Kilkenny).

Mr. Crawford

I commend Deputy Shatter for having highlighted the serious ongoing situation regarding junior hospital doctors. There has been an alarming deterioration in our health services at a time of unprecedented economic prosperity. The hours that junior hospital doctors work not only pose a risk to doctors' health but, more seriously, they undermine their capacity to provide proper patient care. I listened with interest to Government backbenchers agreeing with what Deputy Shatter said – that the doctors have a genuine grievance about unfair treatment. I hope, perhaps in vain, that those backbenchers will act accordingly if the matter comes to a vote. Is any other group asked to work overtime for half the normal pay? Is it any wonder that 98% of non-consultant hospital doctors voted for industrial action when they have not even been paid the money they were promised? Under the law, lorry drivers are limited in the number of hours they can drive. The period during which their lorries are being loaded or unloaded is not permitted as rest time. Can young doctors be expected to work 100 hours per week and still remain fully alert for their patients?

As you are fully aware, a Leas-Cheann Comhairle, there is a serious situation in Monaghan General Hospital. Three years ago, a £5-million plan was put forward by the health board, which was both necessary and essential for doctors to provide a proper service. Three years later, although many committee structures have been set up, action has not yet been taken on the matter. The Minister and others concerned in running the health service, should make sure the money is made available forthwith. If that was done, a proper level of health care could be provided at Monaghan General Hospital. There is much goodwill there but it is running out because of the serious delay in implementing the North Eastern Health Board's action plan. We can no longer take no for answer. We want the funds now.

Mr. Stanton

There is something rotten in the health service at present. There is no doubt about that. This is an example of where the economy is working but the Government is not. Things are getting worse instead of better, and waiting lists are growing. The people who are suffering are, in the main, the old and infirm. Old people in pain are lying on trolleys for hours in our hospitals with broken hips and other ailments. On top of all this, the Government and the previous Minister, presided over the first national strike by nurses in the history of the State. That is a great honour for the Government to tag on to its curriculum vitae for the next general election. It will not be forgotten.

The Government is now in danger of presiding over another strike in the health services by junior doctors. The strike is only one symptom of the underlying malaise caused by the inaction and uncaring attitude of the Government to those who are most vulnerable and at highest risk in society – the poor. Fine Gael is calling on all sides in the dispute to get together for talks. In particular, the Minister should enter into substantial negotiations with the IMO. This dispute had to be resolved. The nurses strike was resolved eventually and this dispute will also have to be settled. Why do we have to have a strike, therefore? The Minister is at fault for not talking to those involved. The same thing happened with the nurses; the Government decided to make an example of them, but the Minister eventually had to discuss the situation. The Government will have to do it again and it should do so now. The Minister should have a realistic discussion with the doctors involved, not just a holding or bluffing measure.

We are supposed to be in a Celtic tiger economy yet, amazingly, older people are ringing TDs because they require medical treatment. A man rang me recently and asked what he was going to do because his hip was causing him terrible pain. What do I tell that man who is on a very long waiting list? The lists have got longer because of the Government's inaction. They were increased by the nurses' strike and the doctors' strike will have the same effect. In addition, doctors are leaving the country in droves because of better employment conditions elsewhere. The Government must also address that issue, which is as serious as the impending strike, if not more so. We will lose our best hospital doctors in the long-term. Where will we get replacements for them? The Government is storing up further trouble down the road. This is not good enough.

Mr. Boylan

I am glad to have the opportunity to speak on the very emotive issue of our health services, which are in a shambles. The Minister and the Government must take responsibility for this. The indictment of this is the waiting lists, which are a sad reflection on the previous Minister's term in office. He lost the goodwill of the people, the voluntary sector which backed up every hospital, and the dedicated nurses. I have often said in the House that a nurse is born, not made. People who are dedicated to the care of the sick were forced onto picket lines and starved off them. The Minister is now attacking the junior doctors. However, the most vulnerable people are being exploited, that is, the sick who are in hospital beds, if they are lucky enough to get one.

The North Eastern Health Board area, which is the most disadvantaged area in the country and has the longest waiting lists, experienced an 83% increase in waiting lists during the term of office of the previous Minister, Deputy Cowen. That does not surprise me because the health boards are not concerned about care or health. The North Eastern Health Board is concerned about circumventing the planning laws. I want the Minister, who I know is a reasonable man, to take note of the fact that the North Eastern Health Board has spent the past 12 months trying to impose parking charges at Cavan General Hospital. That hospital was built with subscriptions from the people of Cavan and the health board was asked to administer the health care in it, of which it is making a shambles. It erected barriers 12 months ago so it could impose charges on people attending the hospital as patients or visiting family members. That was stopped when I drew attention to the illegality of the board's actions and it has spent the past 12 months with its legal advisers to see how it could circumvent the law to erect barriers and impose these charges. Last Monday, against the wishes of the people and the goodwill of the friends of Cavan General Hospital, the executive of the North Eastern Health Board erected its barriers. Now one has to pay to attend Cavan General Hospital as either a patient or a visitor. That is all the board is concerned about. An old lady told me that when she went to the hospital to have her hand attended to there were 12 people to take her name and address but there was no one to put a bandage on her hand. That says it all and this is happening nationwide.

I compliment Deputy Shatter on giving us the opportunity to examine this terrible mess. We cannot administer a decent health service for a population of 3.5 million people. There is nothing but complaint after complaint. We have the finest equipment, doctors and surgeons but it is impossible to see them. I do not blame those people who work long hours. However, the administration of health services in this country is in a shambles. The Minister is in charge and must take responsibility. If the health boards are not doing their duty and are top heavy with administrative staff without enough staff to administer health care, it is time to re-examine that. There are far too many people with good jobs who have no idea how to treat patients. They sit in offices and dole out reams of paper about costs, charges and so on. However, as the poor old lady said, there is no one to bandage a finger. It is time that stopped.

The previous Minister left an unholy mess behind him. It is time we took a serious look at this and gave our people the care they deserve. I thank Deputy Shatter for the opportunity to raise this matter.

Ms Clune

I support the motion tabled by Deputy Shatter and thank him for giving us the opportunity to air our views on this issue. I feel very strongly about the condition of our health services. While the nurses' strike ended before Christmas, there is still unrest among nurses who are unhappy with the situation, many of whom are voting with their feet. The same is true of non-consultant junior hospital doctors.

We have been aware for a long time that junior doctors work long hours, which are unfair and unnatural. While this could be seen as exploitation, it was always passed off by saying it was part of their training and that they would forget about it when they were consultants. However, they have the support of the senior consultants in this action.

This situation is not good enough, particularly in regard to patient care. Many issues have been highlighted in the House today and last night and in the media in regard to the horrendous hours junior doctors must work. Nobody can function under those conditions and it is putting patient care at risk.

Junior doctors have already spent a long time, six or seven years, in college. They are in a very difficult position. Many of their peers in other professions and jobs are able to buy houses and cars and take holidays. Junior doctors cannot afford to do that or to start families in their twenties, as many of them would like to, which is an unnatural situation and probably one of the reasons so few women make it to consultant level in hospitals. I have no doubt that women find those hours unbearable, particularly if they marry or want to have children in those years. The horrendously long hours contribute to the fact that there are so few women at consultant level.

There is very low morale in our health services. Waiting lists have increased continuously since the Government took office. A strike by non-consultant hospital doctors would further increase those waiting lists. It is the doctors and nurses dealing with patients who must explain to them that there are no beds and that they must spend nights on trolleys. We all hear stories daily which make us very uncomfortable. It is very difficult to give answers to people in that situation and their families.

The Minister cannot solve the problem in our health services without the support of the junior hospital doctors. I call on him to speak with the IMO in an effort to resolve the situation rather than letting a strike take place. We have a week in which I hope the situation can be resolved.

Mr. Browne

(Carlow-Kilkenny): I am delighted to support the motion tabled by my colleague, Deputy Shatter, for two reasons. The first is that it is a very serious motion and the second is that I am delighted I survived a visit to a hospital. I want to thank you publicly, a Leas-Cheann Comhairle, for talking me into having some common sense and going for a check-up. But for you, I might not be contributing to this debate. This is my first contribution since the last century and I am delighted to be back.

This motion is extremely important. I feel very sorry for junior doctors. I understand their situation because of my recent hospital visit. When I was there, the lady doctor on duty I met at 11 a.m. had been there since 7 p.m. the previous night and was going to be on duty for the rest of the day. It is grossly unfair to expect anyone to go on regardless. Someone made the excuse that they can have a snooze – I am sure they do not get a satisfactory sleep if they are woken up after a quarter of an hour and have to go back to work. It is unbelievable in this new millennium that doctors are treated in this way. It seems to have been taken for granted that they should do this.

It is grossly unfair to them and to the patients after whom they look. Who needs to be more alert than a doctor who administers medicine and so on? If they are suffering from fatigue, the patients are at risk. It also means they are not in good humour as they should be. People who are sick need people to be pleasant to them. It is hard to blame somebody who is exhausted if they are not in as good a humour as they should be.

Someone said they are only starting off in their careers and that they will finish up as consultants. Maybe they will, but one has to live long enough to be a consultant. If one is dead before one reaches that stage, one is no use to anyone, including oneself. Consultants are important and I praise them for their wonderful skills. We appreciate all they do.

I would like to make a general comment on the health services without repeating much of what has been said about waiting lists and so on. As we all know, there is a long queue for operations. A family member of a person on a medical card decided to pay for that person's hip operation. That person decided to get an X-ray and mentioned they were going privately as they were fed up waiting and straightaway they were charged for that X-ray. If people with medical cards are prepared to go privately and to pay for operations, it would be a good investment on the part of the Department of Health and Children, the Department of Social, Community and Family Affairs or any other Department to at least provide some facilities rather than say that because they are going privately, they will be cut off. It is a short sighted policy and it should be looked at.

Mr. Allen

The junior doctors' strike is the tip of the iceberg of the problems in our health services. We will see those health services dissolve into chaos if urgent action is not taken by the Minister. If the current issues are not resolved quickly, hospitals will not only be left without junior doctors for a few hours, days or weeks, but indefinitely. I spoke to a number junior doctors in recent days and they told me they can see a mass resignation of junior doctors and that within one month or two anything between 80% or 90% of junior doctors could have handed in their notice. As Members will know, this happened in other countries and forced major reform of the system. I sincerely hope the Minister will not wait for this Doomsday situation to arrive before he tackles the long festering problems affecting junior doctors.

Mass resignation could serve as a more attractive option for many disillusioned NCHDs because it would eliminate for them the dilemma of strike action which many of them see as a major problem in their role as concerned and caring people. There will be a haemorrhage of junior doctors from Ireland to countries like our nearest neighbour, the UK, because the UK is putting in place a better training system. Over there, junior doctors make much better progress at a quicker rate within the system. Junior doctors realise that and are setting their sights on getting out of the system which has exploited them for so long.

The United Kingdom is currently trying to recruit an additional 7,000 doctors in order to bring the working hours for junior doctors in line with the European Union regulations. This, in itself, with pose an even greater threat to the Irish health services because junior doctors know that if they leave here to go to the UK, they are guaranteed better working hours, training, pay and prospects. The challenge for the Government is to develop a system which not only keeps the doctors we have here, but also attracts people back to this country. That is absolutely necessary.

I received some shocking statistics in recent days from the Southern Health Board area showing the length of time people must wait for in-patient admissions. At Cork University Hospital, the figures are unbelievable and frightening. People wait an average of 85 months for urology, 75 months for plastic surgery, 61 months for ophthalmology, 25 months for cardiac surgery, 17 months for cardiology, 43 months for gynaecology and 38 months for neurosurgery.

At Tralee General Hospital, there is a 32 month waiting period for gynaecology, 32 months for surgery, 24 months for orthopaedic surgery and 40 months for ENT procedures which are essential for young people at an early age to enable them develop before they go to school. In Cork, St. Mary's Orthopaedic Hospital has a waiting list of 48 weeks for orthopaedic surgery.

The industrial action, if it proceeds, will be a disaster for thousands of sick people who are expecting treatment for their illnesses and diseases. I ask the Minister to get into realistic negotiations with the IMO and to put forward proposals which will convince junior doctors that he is genuine and serious about resolving the problem.

Minister of State at the Department of Education and Science (Mr. O'Dea)

I commend my colleague, the Minister for Health and Children, on his handling of this issue and also endorse the Government's handling of this dispute. I appeal to the Irish Medical Organisation to enter into the mediation process because for its part, the Health Service Employers Agency, has always accepted invitations from the Labour Relations Commission and/or the Labour Court. It has always accepted the findings of those bodies and, indeed, it has adhered scrupulously to whatever those findings or recommendations were.

Deputy Theresa Ahearn claimed the Government has not valued nursing and spoke of the reluctance of people to apply for nursing posts. I would like to inform the House that the number of applications for student nursing posts is double the number of available places.

In relation to junior doctors, the Government fully accepts that some NCHDs working hours are too long and need to be reduced. It also accepts that an enhanced training arrangement is required to keep young doctors at home. Furthermore, the Government accepts that difficulties can arise when NCHDs move house during their career. The Government also accepts that a new arrangement for overtime needs to be put in place.

The industrial relations machinery of the State has been in place to resolve this type of conflict between junior doctors and health service employers and I urge the Irish Medical Organisation to avail of this machinery. Deputy McManus misinterpreted what Deputy Batt O'Keeffe said last night. Deputy O'Keeffe was not blaming patients for our difficulties but was indicating the challenges facing the health services at present, which we all recognise. This Government has put huge resources into the health services since 1997, namely, £1,500 million. This significant additional funding of £1,500 million is very substantial when compared to the previous Government's investment of just under £400 million.

I accept the difficulties with junior doctors' working hours have been with us for 20 to 30 years. Problems which have existed for so long cannot be solved with the stroke of a pen. It takes seven years to train a doctor and another year is spent as an intern which means that from today, it would take over eight years to produce a large number of additional NCHDs from our universities. The nine year period for implementation of the 48 hour week is not used to long finger the proposal but to allow time for its implementation.

I am satisfied that the best course of action to deal with the complexities of this case – and it is extremely complex – is independent third party negotiation. The Labour Relations Commission has agreed to examine the issues affecting non-consultant hospital doctors. The Health Service Employers Agency, on behalf of health service employers, has agreed to participate in this process. Again, I ask the Irish Medical Organisation to agree to mediation so that the difficulties can be resolved, both for the benefit of patients in our hospitals and the well-being of junior doctors.

The proposed industrial action on 17 May will not, of itself, resolve this dispute. It will have to be resolved through the efforts of all the parties. The Irish Medical Organisation should, therefore, enter into discussions under the auspices of the Labour Relations Commission.

Mr. McGinley

I wish to share my time with Deputies McCormack and Shatter.

The non-consultant hospital doctors have a vital and pivotal role in the provision of health services. Without the services of junior doctors our health services would grind to a halt overnight. It is not an exaggeration to say that they are probably one of the most exploited groups within the health care sector. What other group is expected to work between 80 and 100 hours per week and can at times be on continuous duty for up to 36 hours? Everyone agrees that alertness and concentration are crucial when ministering to the sick. Can we reasonably expect such levels of concentration and alertness from people who may be suffering fatigue and weariness after 36 hours of continuous duty? These Victorian work practices lend themselves to an unacceptable level of alertness and concentration which are such essential elements in providing care for hospital patients. One can justifiably say that such work practices are not alone unacceptable from the point of view of providing health care, but hazardous to the health of the junior doctors. That 98% of non-consultant hospital doctors voted for industrial action in support of shorter working hours, higher overtime rates and better staffing ratios speaks for itself.

If this strike is allowed to take place it will lead to longer waiting lists. Last October we had the first nurses' strike in the history of the State. This strike was brought about because the Government and the Minister refused to enter meaningful negotiations with the nurses' unions. While the work stoppages contributed to an increase in the hospital waiting lists, the Government was eventually forced to initiate talks and to address the long-term grievances of the nursing profession.

I cannot think of any other sector where class division is more apparent than in the provision of medical services and hospital care. We have a two-tier health system with private and public sectors. If one is fortunate enough to be able to afford private medical care there are no waiting lists or delays. Beds are readily available within hours and the necessary procedures are carried out almost immediately. These people are not worried about waiting lists or delays. It is a super-efficient, cash on delivery service. However, the situation is completely different for those dependent on the public health system. They are subjected to long delays in seeing a consultant before even graduating to the waiting list. This has been described by Deputy Shatter as the waiting list to get onto the waiting list. These waiting lists are getting longer at both national and regional level. During the lifetime of this Government, hospital waiting lists have increased by 30%, despite unprecedented economic prosperity. According to the latest available figures, there are now almost 37,000 patients waiting for hospital care, probably the highest number on record.

In the North Western Health Board area matters have deteriorated to critical levels. Between March 1997 and December 1999, the waiting lists of the two major hospitals, Letterkenny and Sligo, increased by 26%, from 1,707 to 2,146. In Letterkenny the list increased by 21% during that time, from 583 to 704. In Sligo the position is even more critical and the increase was 28%. These figures, of course, do not include people from Donegal and the north west who may have been referred to hospitals outside the area, those who may need cardiac or oncology procedures in Dub lin or elsewhere. Seriously ill people are forced to spend their life savings to obtain urgent and essential medical services in the private sector. Depending on their public health service means continued suffering over prolonged periods. The necessary resources must be provided to the health services so that this national scandal can be addressed in a serious and meaningful way. If the junior doctors' strike is allowed to take place, and perhaps escalate, it will lead to longer waiting lists and extra suffering for those dependent on the public health sector.

The health services are disintegrating. Nurses had to strike last October. Next week it will be the turn of the junior doctors and we learned this morning that next month it will probably be the turn of the psychiatric nurses. The system is falling apart and the Minister and the Government seem to be paralysed. Unless we address the genuine grievances of our health workers we are heading for a crisis of our own making.

The quality of the health service available to the people is an indication of the level of justice in our society but we seem to be very far down on that scale. I appeal to the Minister and the Government to defuse this serious situation before it becomes worse and subjects our people to further hardships.

Mr. Shatter

I thank those who have contributed to this very important debate on another of the issues relevant to our health service which arise due to the total incompetence of the Government. I thank those who spoke on this side of the House, including Deputy McManus and her Labour Party colleagues. It was clear from some of the contributions from the Government side that some Government backbenchers are not resting too easy with the Government's approach to health issues, particularly with the manner in which junior hospital doctors are being treated. Having gone through the time honoured genuflection in the direction of the Minister for political reasons, some of his colleagues set out quite clearly their very real concerns.

I listened with great interest to the Minister's speech last night. I was hopeful that he would have something to say that would point us in the direction of a solution to the crisis with which we are confronted. The Minister's speech was more remarkable for what he omitted than for what he included, much of which was a litany of background information with which we are all familiar and of which the IMO and the junior doctors have heard for many months.

The Minister had nothing to say about a number of very important issues. I raised the fact that there are junior doctors who have worked overtime and who find that the only way to get paid by hospitals for overtime worked is by threatening legal action or going to the Labour Relations Commission. I asked the Minister that all overtime due to junior doctors for work properly undertaken by them be discharged and that he direct health boards and hospitals to treat their employees properly. The Minister was silent on the issue of arrears of overtime. I drew to the Minister's attention the fact that under the partnership agreement, junior doctors should have received their 1% increase in salary, which began at the beginning of April, in their salary cheques at the beginning of May but that they have not yet received their 1% increase. I asked the Minister to ensure this was paid. This is an issue which should not have given rise to any difficulty, yet the Minister had nothing to say about it.

In the context of pretending that something of note was happening, the Minister referred to the fact that the Health Service Employers Agency has indicated that it is prepared to honour in full its commitments regarding the 1997 contract and wishes to ensure that commitments are complied with. Why has it taken the threat of industrial action for the HSEA to say it will honour the current 1997 contract? This should have been honoured from day one. Why has the Minister or his predecessor not ensured that it was honoured? Why has the Minister or his predecessor not ensured that faith was kept with junior doctors so that they knew, when agreements were entered into with the HSEA, that they would be honoured and complied with by the State bodies and hospitals whose funding is provided by the State? This should not be an issue. This is part of the problem with the functioning of the health service whose administration is incapable of maintaining a modern system in operation, which is slowly disintegrating and treats with contempt not only patients waiting up to three years on in-patient hospital waiting lists but the service providers – nurses and doctors – who are given no respect for what they do.

Some of the language used in the speech delivered by the Minister last night is indicative of the psyche of the Government and the thinking in the Department of Health and Children. The Minister said, "Young doctors tend to leave at the point where they have just acquired the skills and expertise and are ready to make a real contribution to Irish hospitals." Is he saying, on behalf of the Government, that newly qualified doctors, on whose backs rested the great weight of maintaining a functioning public hospital system, made no contribution of value in their first year or first two or three years working in our hospitals? Is that the psyche? Junior doctors are of the view, as nurses were, that no real value is attached to the work they do not only by some of the health boards and hospitals for which they work but also by the Minister and the Department.

Their view that they are treated in an unacceptable manner derives not merely from the fact that the Minister and the Department have no interest in the reality that they are not properly paid but also from the fact that, although the maximum number of working hours per week is supposed to be 65, they are working up to 100 hours per week. That amount of work in any one week in any profession is not sustainable. In the context of a profession in which one develops skills which enables one to diagnose whether patients are suffering from life threatening illnesses, this is something which the people and members of all parties in the House should not tolerate in the 21st century.

In his self-serving amendment to the motion, traditionally tabled by Governments on Private Members' time, the Minister asks Dáil Éireann to endorse the Government's handling of the current dispute. For six months discussions took place with the HSEA. Yet, no substantive proposals were made. The IMO is not entering into discussions with the Labour Relations Commission because there is nothing of substance on the table that the parties can discuss and conciliate and on which they can negotiate. The Government has sat back and watched yet another health crisis develop. There is to be a one day strike next week and a two day strike the following week with the possibility of an all out strike by the end of this month. This would have a detrimental impact on patient care and a dramatic impact on hospital waiting lists which at the end of December stood at 37,000. Judging from the leak from the Department following the Cabinet meeting on Tuesday, which was no doubt designed to soften up the media so that when the actual figures are released it will not regard them as news, no real dent has been made in the figures in the first three months of the year.

The Government has proved itself to be completely incapable of properly managing and running the health service. It does not deserve to win the vote in the House this morning. The Minister has a clear duty. His duty is to intervene now to ensure substantive real proposals are placed on the table which can lead to discussion, negotiation, conciliation and resolution of the dispute in a manner which is satisfactory to junior doctors and which protects patients and avoids a strike next Wednesday.

In the context of the formal votes which take place in the House on Private Members' time, we know the numbers add up on the Government side and that some of the so-called Independent Deputies, such as Deputy Healy-Rae, who are really Independent Fianna Fáil automatically vote with the Government. Deputy Healy-Rae who is very vocal on all sorts of issues has not bothered to come into the House for any portion of the debate on this important health issue or attempted to contribute to it. In case he is watching on the monitor, I remind him that his nephew who worked until last summer as a junior doctor in Cork University Hospital decided that he would be better off playing the bodhrán in Thailand than working in our health service.

Mr. Martin

That is not fair.

Mr. Shatter

He has taken time out because of the pressures and difficulties he experienced as a junior doctor. Perhaps for family reasons as opposed to personal political advantage Deputy Healy-Rae will finally vote with the Opposition in this debate.

Amendment put.

Tá

Ahern, Dermot.Ahern, Michael.Ahern, Noel.Ardagh, Seán.Aylward, Liam.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Callely, Ivor.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cullen, Martin.Daly, Brendan.de Valera, Síle.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.

Jacob, Joe.Kelleher, Billy.Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael.Lawlor, Liam.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.McDaid, James.McGennis, Marian.McGuinness, John.Martin, Micheál.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.O'Rourke, Mary.Power, Seán.Roche, Dick.Smith, Brendan.Smith, Michael. Tá–continued

Treacy, Noel.Wade, Eddie.Wallace, Dan.

Wallace, Mary.Woods, Michael.Wright, G. V.

Níl

Ahearn, Theresa.Allen, Bernard.Barnes, Monica.Barrett, Seán.Boylan, Andrew.Bradford, Paul.Broughan, Thomas.Browne, John (Carlow-Kilkenny).Bruton, Richard.Burke, Ulick.Carey, Donal.Clune, Deirdre.Cosgrave, Michael.Crawford, Seymour.Creed, Michael.Currie, Austin.Deasy, Austin.Deenihan, Jimmy.Durkan, Bernard.Enright, Thomas.Finucane, Michael.Fitzgerald, Frances.Flanagan, Charles.Gilmore, Éamon.Gormley, John.Gregory, Tony.Hayes, Brian.Higgins, Jim.Higgins, Joe.Higgins, Michael.

Hogan, Philip.Howlin, Brendan.McCormack, Pádraic.McDowell, Derek.McGahon, Brendan.McGinley, Dinny.McManus, Liz.Mitchell, Gay.Mitchell, Olivia.Moynihan-Cronin, Breeda.Naughten, Denis.Neville, Dan.Noonan, Michael.O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Owen, Nora.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Ryan, Seán.Sargent, Trevor.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Stagg, Emmet.Stanton, David.Timmins, Billy.Upton, Mary.Wall, Jack.Yates, Ivan.

Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Barrett and Stagg

Amendment declared carried.

Question, "That the motion, as amended, be agreed to", put and declared carried.