I welcome the Minister of State to the House. It has been health all the way today in one form or another. I know that we have a serious problem to deal with at present, namely, the approaching nurses' strike. However, I must bring to the Minister of State's attention the lack of concern that the Department of Health and Children appears to have in respect of the complaints which have been made by non-consultant hospital doctors. Apart from nurses, the mainstay of the hospital system at present is the work carried out by these doctors. The Minister of State and I served our time in that category, so he will have a good idea what I am talking about.
This problem has been simmering for years but matters came to a head following moves made in the European Parliament on the ban on anything over a 56 hour week for non-consultant doctors and the call to reduce the number of hours they work each week to 48. A Belgian MEP, Miet Smet, has put forward a proposal that the 56 hour week must be introduced by the year 2002 and that the 48 hour week must be in place four years later. The Minister of State will be aware that earlier this year when this topic was discussed by the European Parliament and the Council of Ministers, progress in this area was blocked by two European ministers, namely, the Minister for Health and Children and his UK counterpart.
The United Kingdom Government would appear to have capitulated to the demands of non-consultant hospital doctors for a shorter working week. It is important to remember that they already have a much shorter working week than doctors in this country. In the United Kingdom it is reckoned that a senior house officer who works one night per week works 56 hours. It is also estimated that only 20 per cent of senior house officers work such hours. In this country it would be more accurate to say that 80 per cent of non-consultant doctors work more than 56 hours per week. I warmly welcome the presence of some of them in the Visitors' Gallery. The fact that they have been able to get here, having worked until 9 p.m., shows the enormous concerns the leaders of the junior doctors have on this matter.
Long hours have been traditional but I become extraordinarily tired of those doctors in more senior positions who say "We worked those hours, why cannot those working in the medical field do the same?". That is ridiculous. Because a practice is bad now does not mean it was not bad then. Most junior doctors work in excess of 80 hours per week and some work more than 100. This is extraordinarily bad for them, as people, and we realise that the stress it has placed on them has caused a considerable number to leave medicine in the past number of years. Figures from the United Kingdom for the past decade show that between 10 per cent and 20 per cent of those involved in the medical profession leave within ten years of qualifying as doctors. I have spoken to numerous young doctors who, rather than working on the front line in the medical service, have gone into different fields. The hours are very hard, physically and mentally, and lead to alcohol and drug abuse. In fact, suicide has been the solution taken by a few people.
The position in the United Kingdom is better and it is a place to which doctors can easily emigrate. It is noticeable that the majority of interns in this country are Irish citizens but as one goes up the non-consultant hospital doctor pyramid one finds that between 50 and 60 per cent of senior house officers are Irish and while a certain proportion of registrars in the teaching hospitals in Dublin and the major centres like Galway, Cork and Limerick are Irish, yet outside these centres we depend totally on non-EU graduates – and when I say totally, I mean 100 per cent – to look after the Irish population.
The people working in Irish hospitals see a constant increase in the number of administrators in the health service and a decrease in those working at what I have described as the coal face. This leads to people feeling very unappreciated.
The increasing complexity of medicine, not to mention the increased level of litigation, means that every hour on duty is far more stressful than it used to be. Patients have higher expectations and these will not be met by exhausted doctors. Being on call and overworked frequently leads to more court cases. Patients and their families expect a great deal more and it is the junior hospital doctors who must deal with these expectations.
Training is not adequate in a large number of our hospitals outside the major teaching centres. Hospitals are having to rely on non-EU nationals but we now face the serious situation of the withdrawal by the Medical Council of accreditation for the education of non-EU doctors from some of these small hospitals. We will, therefore, have a smaller number of non-EU doctors coming here and we will be in an appalling position in a very short time. I have brought up the problem of non-EU doctors during several health debates. They are charged very large sums to come to do examinations and register here – the starting point is just £1,400 which is a lot of money for someone coming from a third world country who is coming to get further training. However, these doctors often end up in hospitals where the training is not accredited and we may lose them.
The Institute of Obstetricians and Gynaecologists is withdrawing accreditation for training of junior doctors from all maternity units with fewer than three consultants. The Minister of State knows that this means virtually all small units throughout the country. Patients are calling for small units to be kept open but we have a few one consultant and quite a few two consultant units and the withdrawal of recognition from these will mean that we have no units providing training throughout the country.
Many people think that non-consultant hospital doctors remain in the job for a year or two and then proceed to positions with large salaries. This is not so. In general, they are in these positions for seven to ten years and this has a serious effect on them. More than 50 per cent of medical school graduates are women and working conditions are even more difficult for women who, in general, take the greater burden of child care so that their progress in medicine if far more curtailed than it should be. This affects the promotion prospects of women doctors and impacts on family life.
Despite greatly improved pay and conditions in the United Kingdom, junior doctors there still refuse to agree to the remuneration bands put forward for them. They have better conditions than our doctors and I do not wish to see Ireland remain the only country in the European Union which refuses to bring in proper working conditions for non-consultant hospital doctors. I ask the Minister of State to urge the Department to address this matter before we get to the point of having people leaving Ireland immediately after graduation if they are Irish citizens, no non-EU nationals coming in because we cannot fulfil their expectations and a medical service bereft of those who do enormous work running it on a day to day basis.