Is that agreed? Agreed.
Private Notice Question. - Industrial Disputes.
An Leas-Cheann Comhairle:
asked the Minister for Health and Children to outline how he will respond to the current dispute of the public health doctors and particularly how he intends to deal with the threat posed by SARS and the preparations for the Special Olympics.
asked the Minister for Health and Children the steps being taken to seek a solution to the strike of public health doctors which commenced on 14 April 2003, in view of the vital role played by these doctors in combating infectious diseases and of the potential threat of the spread of SARS; the procedures which have been put in place to provide emergency cover; and if he will make a statement on the matter.
asked the Minister for Health and Children the steps, if any, he has taken to deal with the current strike by public health doctors; the implications this strike may have if there is a serious outbreak of SARS here; and if he will make a statement on the matter.
At the outset, I wish to again state, on behalf of myself and my Government colleagues, our serious concern at the national strike action taken by public health doctors in pursuit of a 30% pay claim. I strongly urge the IMO to cease this unwarranted action, particularly in view of the recent agreement on a new national pay deal, Sustaining Progress, and to participate in the processes which are available to resolve this dispute.
I also wish to record that this claim has been lodged in relation to the current duties and responsibilities of these doctors and is separate to any pay increase that the Irish Medical Organisation has indicated that it will demand for the implementation of changed working practices that may be required in the future.
It is important to clarify the background to the current dispute, especially in view of the variety of selective historical accounts that are being circulated.
The regional public health function was established in 1994, comprising the grades of director of public health, specialist in public health, senior area medical officers and area medical officers. A full review of the public health function commenced in 1999 with the report of the public health review group, the Brennan group, issuing in April 2002. The IMO were equal partners and co-owners of this review process. The HSEA, the Department of Health and Children and the health boards accept the recommendations contained in the Brennan report. The report does, however, reflect the diverging views between the parties on the issue of consultant status for public health doctors. The chairman's role was that of facilitator to the working party and not that of an arbitrator. His comments in relation to the status of directors and specialists were no more than a personal view and as such had not the status of a recommendation.
The only recommendations contained in the report were on those issues on which the parties were in agreement. It should also be noted that the Brennan report acknowledged that there might be a need to revisit its recommendations following the implementation of proposed changes recommended by the health strategy, entitled Quality and Fairness, and the primary care strategy. Both of these strategies, and the forthcoming report on the audit of structures in the health service by Prospectus, will have significant implications for the future role of public health doctors and, as such, must be taken fully into account in any negotiations process.
In 2002, following extensive consideration of a detailed submission by the IMO the Public Service Benchmarking Body recommended increases for public health doctors ranging from 2.5% for a specialist in public health medicine to 14.2% for a director of public health medicine. In making these recommendations, the benchmarking body was determining the rate of pay which should apply to the various public health posts based on their duties and responsibilities as of 30 June 2002. It is also important to note that these duties and responsibilities have not changed in the interim. The benchmarking body did acknowledge that it was not in a position to take account of the issues raised by the Public Health Review Group in relation to the restructuring of public health service provision.
The health strategy envisages a population health division being established in each health board, incorporating such areas as public health and health promotion units. These developments will obviously be influenced by the outcome of the restructuring proposals which are currently being finalised and must be central to any consideration of the future role and responsibilities of public health doctors. I feel it is necessary to reflect on the key issues at the heart of this industrial relations dispute.
The Irish Medical Organisation, the representative organisation for public health doctors, has lodged a claim for a 30% pay increase, in advance of any discussion or agreement on future changes in work practices arising from the negotiations on the Brennan report or that will be required under the health and primary care strategies or the Prospectus report. This claim is in addition to increases of up to 14% which have been approved by the Public Service Benchmarking Body and the 7% increase which will be paid under the terms of the new national pay agreement, Sustaining Progress.
Contrary to IMO suggestions that the Department of Health and Children did not favour or support the intervention of the Labour Relations Commission, it should be noted that Department officials, as part of the management team, have attended a number of LRC hearings with the IMO. In the context of these discussions, management made a substantial offer to the IMO in an attempt to resolve this dispute. A cumulative increase of up to 25%, inclusive of the increases approved under benchmarking, has been rejected by the IMO. On top of this amount the public health doctors will receive a further 7% under the new national agreement. In monetary terms these increases would translate into very substantial amounts.
The salary of directors of public health will increase by €29,000, from €82,000 to €111,000 per annum, a cumulative increase of 35.39%. The salary of public health specialists will increase by €17,000, from €78,000 to €95,000 per annum, a cumulative increase of 21.52%. The salary of senior area medical officers will increase by between €17,000 and €19,000, from between €55,000 and €63,000 to between €72,000 and €82,000 per annum, a cumulative increase of 30.41 %. The salary of area medical officers will increase by between €11,000 and €13,000, from between €48,000 and €56,000 to between €59,000 and €69,000 per annum, a cumulative increase of 22.11 %.
I put it to the House that increases of this magnitude do not warrant industrial action, let alone a national strike. I am sure it will not go unnoticed that the potential increases themselves are in excess of the average annual industrial wage. Unfortunately, I am left with the impression that the IMO has a preference for strike action rather than mediation or resolution. It is unprecedented in the history of Irish industrial relations for any union to have refused to participate in proceedings in the Labour Relations Commission or the Labour Court in the weeks leading up to the strike.
Both the Health Service Employers Agency and my Department have written to the Irish Medical Organisation indicating their opposition to the current action and requesting the reconvening of talks at the Labour Relations Commission or a referral to the Labour Court. A management team, comprising officials from my Department, the Health Service Employers Agency and the health boards, held negotiations with the Irish Medical Organisation in the Labour Relations Commission on a number of occasions in recent months. I understand that the HSEA has accepted an invitation from the Labour Relations Commission to resume discussions and has urged the IMO to participate in this process.
I have previously requested the Irish Medical Organisation to return to these negotiations or to accept my invitation to attend the Labour Court. Both of these offers have been refused by the IMO in the weeks leading up to the strike. I now again request the IMO to reconsider its position in this matter in an attempt to resolve the current impasse. Further ministerial intervention at this stage is neither appropriate nor necessary in view of the processes available to the IMO through normal industrial relations channels.
Talking about industrial relations practices and protocols brings me to another worrying aspect of this dispute – the difficulty in obtaining agreement to or clarification of the IMO arrangements for the provision of emergency cover by public health doctors during their strike. It is management's firm belief that the IMO requirement that requests for emergency cover should be chan nelled by health board chief executive officers to the IMO national strike committee rather than being dealt with at local/regional level is most unsatisfactory. The refusal of the IMO to meet with management to discuss and clarify issues which arose at a previous meeting on emergency cover is unprecedented. Similarly, the weekend statement by the IMO that there would be further serious curtailment of the already severely limited emergency cover arrangements, the refusal to exempt any director of public health or the director of the national disease surveillance centre or to exclude the activation of major emergency plans from their restrictive requirements raises serious ethical, professional and public safety issues and calls into question the organisation's motives in taking this approach.
Against this backdrop, arrangements have been made to provide contingency planning arrangements at all levels within the Irish health care system. A national contingency planning group will assist and advise on any national issues in relation to emergency responses. This will cover issues related to the expert committees on SARS and biological threats. A national incident room has been established within the Department to liaise with the health boards and health authority and to monitor developments on a daily basis. Advice notices have been placed in the national press and these will be reviewed and reissued if appropriate.
The medical division within the Department of Health and Children is providing an advisory service to the broader health system and meeting international reporting requirements to bodies such as the World Health Organisation and the European Union. In relation to the issue of SARS, I established an expert group in March to monitor the situation as it developed and to provide advice in relation to the measures required to deal with this syndrome. Prior to this strike, the national disease surveillance centre, NDSC, and the Department of Health and Children developed protocols and guidance for hospitals and health professionals which described the syndrome and provided advice on how suspect cases should be managed. In addition, information for the public and health care workers as well as guidance for aircraft cabin and aircraft cleaning staff has also been provided.
The health service agencies will continue to monitor developments in this area in line with the guidelines issued. In that regard, I have been advised that the Health Service Employers Agency has again written to the IMO in relation to emergency cover arrangements and, specifically, those applying to SARS. The HSEA has requested the IMO to restore the public health input in relation to SARS to normal levels, as an exceptional matter, and in recognition of the unique nature of the illness. A reply is awaited from the IMO in this regard.
Each health board and authority has nominated a senior official to co-ordinate contingency arrangements at regional level and details in this regard have been circulated to all health agencies and to the IMO. Local senior management are overseeing the arrangements necessary to ensure effective co-ordinating and response at local level.
I will finish by again urging the IMO and public health doctors, both collectively and individually, to reconsider the course of action which they have undertaken by initiating this unnecessary strike, to return to the Labour Relations Commission to continue negotiations or to seek a joint referral to the Labour Court. I assure them that the Health Service Employers Agency is ready and willing to resume this process at the earliest opportunity.
I thank the Minister for answering these questions on this important issue. I am not here to negotiate on behalf of public health doctors or to get involved in a union dispute. However, in fairness to the public health doctors, the Minister's statement regarding the new national pay deal—
An Leas-Cheann Comhairle:
Deputy, you may ask a question but you may not make a statement.
I realise that. The Minister has referred to the new national pay deal, Sustaining Progress. However, these issues precede this dispute and have nothing to do with it.
These 300 doctors do very unglamorous work. They are not brain surgeons. They are dedicated public servants and mostly women, in fact. They did not go on strike on a whim. This dispute has been boiling up for a long time. It is unfair to say they would not go to the Labour Court when they offered to go to the Labour Court in the past. At that time the Department said there was no need to go to the Labour Court but that it would deal with them. The Department did not deal with them. This is the final straw for the public health doctors.
Does the Minister agree that Ireland is now the weak link in the chain of disease protection because of the absence of a 24 hour rostered service? Our neighbour, Northern Ireland, has expressed concern to the Minister's Department at the gap in disease protection. Does the Minister not agree that we have spent a fortune on tribunals of inquiry to establish why our record is so bad in managing infectious diseases and that the cost of the 24 hour roster would be minute in comparison, given the exposure to infection that could result from not putting it in place?
Sustaining Progress is both relevant and applicable to this dispute. It is my opinion that the IMO is in breach of Sustaining Progress, only a matter of weeks after it was ratified. There are specific provisions in Sustaining Progress in relation to how industrial disputes should be resolved. There is even a specific section dealing with health.
This dispute precedes Sustaining Progress. It is irrelevant.
Sustaining Progress is binding on all signatories to the agreement since the date of ratification. Congress has been advised of that. All parties agreed, for example, that the agreement "precludes strikes or other forms of industrial action by trade unions, employees or employers in respect of any matters covered by this agreement, where the employer or trade union concerned is acting in accordance with the provisions of this agreement". The agreement goes on to refer to utilising the Labour Relations Commission and the Labour Court and avoiding industrial action.
The position is that the Labour Court is not being used. We have suggested to the IMO that we have a joint referral to the Labour Court. The HSEA has been involved in that process within the Labour Relations Commission, is still anxious to resume it, has been invited to go back and has accepted that invitation.
I ask Deputies to reflect on the figure of €29,000, which is the offer on the table. That increase is due, yet people are on strike. I do not think that is acceptable or justifiable. It is well above the average industrial wage.
The grades below that will not get €29,000 but will get the substantial increases of up to €19,000 that I outlined earlier. These are substantial monetary increases by any standards. In that context it is reasonable to say that we should fully exploit the available industrial relations machinery to resolve disputes of this kind.
I accept Deputy Olivia Mitchell's point about a gap in public health provision as a result of the strike.
There was a gap prior to the strike.
That is an unfortunate consequence of the action that has been taken.
We have never had 24 hour cover.
Fundamental issues remain to be negotiated arising from the Brennan report, not least out of hours cover and related logistics. Those matters are for further negotiation.
Does the Minister not agree that wailing about what might have been is pointless? Does he accept that public health doctors are on strike and sooner or later a deal must be struck? Sooner is a lot better than later in circumstances where there are ongoing risks of outbreaks of routine infectious diseases such as measles, meningitis and the winter vomiting bug and the new threat posed by SARS. Does the Minister not feel that he would be better engaged in ensuring there is a formula whereby people can go to the LRC? Indications have already come from the IMO how that can be done. Does the Minister not accept that the people involved are the least militant one could imagine and that their patience has simply run out after many years of delay and bad faith on the part of the Department of Health and Children? It is important that the industrial relations machinery is put into action and that it sorts out the issues but the Minister has a part to play in that rather than bewailing the IMO.
Who is providing the public health expertise to ensure any outbreak is contained, monitored and tracked and that any issues arising are dealt with? Is the Department taking responsibility and does it have the expertise to do so? Who is providing a strategy to deal with SARS as an issue for the Special Olympics? We all welcome the fact that the Special Olympics are taking place in Ireland but it involves 35,000 people travelling here. Is the Department of Health and Children advising these delegations of our poor public health infrastructure? Is it ensuring that all measures are being taken to prevent and contain the spread of SARS in Ireland?
Does the Minister accept that there is a stark contrast between the approach of the Department of Agriculture and Food to the foot and mouth epidemic and the lack of effort made by the Department of Health and Children to ensure industrial action did not happen to begin with? People find it hard to understand why infectious diseases among animals get more attention than those among humans.
Will the Minister comment on the statement from the Minister for Finance that there will be no money forthcoming to resolve the strike?
The medical division of the Department, under the chief medical officer, and through a network of committees in each health board, is dealing with issues that arise in the public health domain. The advice I have received comes from the medical division of my Department and the expert committee continues to meet on SARS. I hope that no one would use the Special Olympics to gain leverage in the dispute.
The World Health Organisation offers advice on these issues and the expert committee at a recent meeting noted that, as of now, the WHO has not issued travel restrictions or quarantine orders on individuals from the affected areas. That could change and with the Special Olympics starting in the latter half of June we will keep that under review.
The national expert committee reports to the European Union and the World Health Organisation and takes advice from the WHO. We have followed all of the recommendations to the letter from the WHO about travel restrictions, issuing notices and warnings to people and issuing protocols to hospitals and doctors about dealing with SARS in Ireland. All of that has happened under the expert committee that I established after the notification of the outbreak of SARS in China and other affected areas. We are keeping the issue under review and will be guided by the World Health Organisation. This is, however, such an exceptional public health threat that it should not come under the remit of the strike. It is a sufficiently grave matter that it should be exempt from industrial action. I support the HSEA in its communication today to the IMO on that.
I am not wailing about anything, my speech laid out the facts. The substantive offer on the table does not merit industrial action. There is a tendency for Opposition Deputies during a strike to say that the Government, Minister or Department should roll over and give whatever is on the table. The Department must protect taxpayers.
It must protect their health.
No one could accuse this Department or this Government of being niggardly in pay and conditions in the health service in the last five years.
Why are the public health doctors on strike then?
There have been enormous increases in the pay budget in health, as everyone knows.
There are enormous dangers to the public now.
The public health doctors will gain €29,000 extra.
Only a small percentage will get €29,000.
There is an increase of €17,000 for public health specialists, a sizeable increase in anyone's mind. There are increases of between €17,000 and €19,000 for senior area medical officers and €13,000 for area medical officers. Most industrial workers would not get anything near that in an increase. There is a €29,000 increase for the directors of public health. All four grades are undertaking industrial action and those figures do not justify that action. Any agreements will have to be paid for out of the budget we have been allocated.
Does the Minister agree that public health doctors have been taken for granted for many years by the Department? In many ways they are the Cinderellas of the health service and it is wrong to approach this by engaging in sabre rattling, as the Minister has done this evening. I understand positions are entrenched at the beginning but we must negotiate and find a solution.
The Minister talked about a cumulative increase of up to 25% then mentioned numerous times that those involved would receive €29,000 of an increase. Over what period will that take place?
The Minister outlined in this speech that the IMO stated at the weekend that there would be a further serious curtailment of the already sever ely limited emergency cover arrangements. That is causing disquiet. He then said we are adequately covered for SARS. How can the Minister square those two statements? It appears the health service has contingency plans in place. However, does the Minister agree that without the public health doctors, these plans are severely curtailed? Does he share my anxiety that if there is a SARS outbreak the country will not be adequately covered because of the strike and that therefore the onus is on him to resolve it as quickly as possible?
I did not go on strike.
The Minister is being facetious.
It is a fair point. I share the Deputy's concern about the SARS virus. The HSEA has contacted the IMO again today with a view to having it exempted from the strike action.
The Minister got his pay increase without having to go on strike.
The virus is of sufficient gravity to merit that kind of response. I am not sabre rattling, but I have made the point that the health boards through the HSEA are available for discussions and negotiation. Industrial relations machinery is in place to deal with this issue.
I have been Minister for Health and Children for a little more than three years. In my first months in office I had to deal with threatened strike action by junior doctors. It went to the wire. The following year GPs were involved in unrest and this year, public health doctors have taken strike action. It appears that the first recourse in these disputes is strike action.
They are taking strike action after nine years.
We alerted the Minister to the possibility of strike action three weeks ago.
It seems that the IMO is involved in a premeditated tactic to create a crisis, threaten and take strike action and get what it wants. A substantive offer has been made and in the circumstances, industrial action is not justified. The public health doctors should fully utilise the available industrial relations machinery. Sustaining Progress is strong on the need to avoid, if at all possible, industrial action in the health sector and on the obligation by all sides to fully exploit and utilise the industrial relations machinery. There is an opportunity for a joint referral to the Labour Court, which the HSEA is willing to take and I appeal to the IMO to join the HSEA in referring this issue to the Labour Court for a decision.
The Minister has focused on the level of increase to be offered to public health doctors, specialists, etc. Will he outline the base from which these increases are cal culated? How do the incomes of those involved, including the senior and area medical officers, compare with their colleagues in neighbouring and continental countries? This information will enable us to make a proper judgment on the increases.
I appeal to the Minister to exercise every initiative to secure an early resolution of this dispute. What steps does he propose to take to address the major deficit in public health alert cover, in the so-called out of hours periods covering evenings, weekends, bank holidays, and so on What steps does he propose to take in the context of the global threat posed by the SARS virus, especially in view of the significant visitor numbers expected over the course of the impending Special Olympics?
The Minister said he does not wish to see the Special Olympics used as lever by any interest group. However, there is a growing and genuinely held fear throughout the country that there is an impending threat to public health. People want to know the steps taken by the Minster and his Department to address this aspect.
An Leas-Cheann Comhairle:
Before concluding, I will ask the Minister to respond to a number of questions from Deputies. I call Deputy Olivia Mitchell.
At the outset I said I would not engage in IR negotiations, but the Minister's uncharacteristically belligerent and aggressive attitude will not be conducive to the resolution of this dispute.
An Leas-Cheann Comhairle:
A question to the Minister, please.
Does the Minister accept that infection does not close down at the Department's closing time of 5 p.m.? Does he also accept that given the increased threat of bio-terrorism and increased mobility in and out of the country, it is lunacy that we do not have the potential to instantly erect a ring of steel around the country on a 24 hour basis, such as we were able to do in the case of the foot and mouth disease outbreak?
Apparently, two nurses are undergoing testing for the SARS virus at their homes. Will the Minister indicate who is monitoring this? He indicated that officials from the health boards have been nominated to act. While I am sure they will do their best, they are not technically or professionally qualified to engage in the necessary surveillance, monitoring, guidance and management of emergent diseases. In view of this, what measures have been put in place?
Does the Minister accept that the decision to take strike action was made before the SARS epidemic began? Does he also accept that there is genuine concern with regard to the Special Olympics and that nobody is raising it for underhand reasons? I represent the town of Bray, which is expecting and hoping to welcome the Chinese delegation. I do not get the impression that sufficient information has been distributed in terms of ensuring that the Special Olympics can proceed and that those involved can feel secure that everything is being done in the proper manner.
If the proposed increased offer to the public health doctors is so good, why are they refusing it? Does he consider it is merely a question of greed?
The WHO has described the SARS virus as one of seven pathogens with the potential to cause the next black death. If it is that serious, does the Minister accept it is his duty to resolve this problem as soon as possible?
Some of the questions have been asked a second or third time. With regard to the Special Olympics, I have made the point that in view of the world-wide nature and scale of the threat posed by the SARS virus, we are guided by the advice of experts in the WHO. The Special Olympics are due to commence next June. In the meantime the expert committee will continue to take advice from the WHO. Closer to the date we may have to make decisions on the best way to proceed. At present, it is too early to make definitive decisions on that aspect.
The WHO is taking this crisis very seriously and we owe it a significant debt of gratitude for the manner in which it has addressed this public health threat. To date, it has not issued any recommendations on travel restrictions or quarantine arrangements in respect of those travelling from the affected areas. We will continue to work with the WHO.
I understand the expert committee has been informed that the alleged cases referred to yesterday are not being notified to the WHO as SARS cases as they do not fit the diagnostic criteria necessary to report them. That is welcome news. The expert committee is monitoring the SARS virus. Prior to the strike action, those involved in public health informed through the National Disease Surveillance Centre, gave advice and produced high quality and important work. There is now a deficiency in this area and I am very concerned about it. The HSEA has contacted the IMO requesting that the SARS virus be exempted from strike action, given the gravity of the issue in terms of a public health threat, across the world and to this country.
Regarding Deputy Ó Caoláin's question, in terms of the directors of public health the levels start at about 82,000 and will go up to 111,000 over the next 20 months. The number of public health specialists will increase from 78,000 to 95,000, of senior area medical health personnel from 19,000 to 82,000 and of area medical officers from 59,000 to 69,000.
How do they compare?
I do not have the continental comparisons with me, but I am informed that our public health personnel are not directly comparable in terms of duties and the range of tasks they perform.