Seanad Éireann debate -
Wednesday, 13 Mar 2013

Vol. 222 No. 2

Adjournment Matters

Health Services Staff Recruitment

Senator Colm Burke

The matter I wish to raise is a new agreement I discovered by accident which has been reached between the HSE and the universities in Pakistan. There is a need to bring the information into the public domain as we got no indication that this was happening. I raise the issue given that more than 200 people were brought in here in 2011 from India and Pakistan under the supervised division created for medical practice. We gave them two-year contracts either from July 2011 to June 2013 or from December-January 2011-12 up to 2014. Those two-year contracts will begin to expire at the end of June 2013. As I understand it, they will not be offered new posts.

I gave the example at the Joint Committee on Health and Children that of the six registrars in anaesthetics, five are employed by the HSE and the sixth is employed by an agency and has refused to take a post as a locum, in the knowledge that nobody else is prepared to accept the post as a locum. Therefore, the HSE is paying substantial money to employ through an agency. There are two senior house officers, SHOs, under the supervised division. I understand that when their two-year contract expires they cannot apply for the post of registrar, even though the people in the hospital have informed me they are suitably qualified. I am concerned at the lack of joined-up thinking in the HSE and the Department on the issue given that up to 250 people who have had the experience of working here for two years will be sent home.

I am concerned at the lack of consultation with the medical colleges and the HSE, in particular the Royal College of Surgeons and University of Limerick. The University of Limerick has many people from Canada who spend four years here doing their medical degree. They get the experience of working in Irish hospitals during the course of those four years and we are not prepared to offer them intern posts. Likewise, I understand the Royal College of Surgeons is not offering intern posts, although the students have been in the education process in Ireland for five years and have the experience of being students in Irish hospitals and are familiar with the way the system works. The HSE and the Department are not talking to those two institutions yet they are prepared to travel to Pakistan and employ people on two-year contracts. I seek clarification on the issue.

I tabled a specific question to the HSE six months ago seeking the number of junior doctors who are on six-month contracts, the number on 12-month contracts, the number on two-year contracts and the number on three-year contracts and I cannot get that information. We need to look at this whole area which will be a disaster from June onwards unless the issue is tackled in a planned way. I am not convinced by the answers I got at the Joint Committee on Heath and Children on Tuesday, 5 March 2013. I am concerned from the Department and the HSE points of view that we are not dealing with the issue in a proper manner.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I am taking this Adjournment matter on behalf of the Minister for Health, Deputy James Reilly.

I thank the Senator for raising this important issue. A memorandum of understanding for a pilot exchange programme between the HSE and the College of Physicians and Surgeons of Pakistan was signed in November 2011. The programme is due to commence in July this year. Doctors who are currently enrolled in CPSP's postgraduate training programmes will spend two years gaining experience and training in Ireland. Participants will have their time accredited for training purposes by the CPSP and this will contribute to their career progression on return to Pakistan. This programme fulfils Ireland's obligations under the WHO Global Code for the Recruitment of Healthcare Workers. It will enable the up-skilling of doctors from Pakistan to the benefit of the health service there. The Senator has also raised non-consultant hospital doctors' employment contracts. There are approximately 4,900 NCHDs employed at any one time. Some 80% of these are training posts and the remainder are non-training or service posts. The duration of the contract held by an individual doctor is determined by factors which include the nature of training or service arrangements and whether the post involves rotation between sites.

I acknowledge that NCHDs fulfil a very important role in providing front-line care and wish to express my appreciation and that of the Minister for Health for the commitment and dedication of these doctors. However, for the most part these are doctors in training and we must ensure an appropriate balance between the provision of care by hospital consultants and NCHDs. It is important to state also that the issue of NCHDs' working-hours is one which the Minister is taking very seriously and plans are in hand to achieve substantial reductions in the number of hours these doctors must work. Entry to postgraduate training and continued participation in a multi-annual training scheme is determined by postgraduate training bodies. While an NCHD may have secured a place on a multi-annual scheme, the length of time that a doctor works in a particular site as part of that scheme may vary and he or she may choose to move between a range of employers in the course of training. The contracts for training posts vary from a one-year contract for an intern to a contract of four to six years for a senior-specialist registrar. Senior house officers who participate in structured two or three-year training schemes may hold consecutive six-month or annual contracts, depending on whether they move location or change employer.

For a number of reasons, largely historical, the HSE operates several payrolls. Where an NCHD moves from one HSE payroll area to another or from the HSE to a voluntary provider, he or she must enter into a new employment contract. I accept that this is not ideal. The move to a shared services model in the coming years should address this issue and enable accurate data to be provided on the number of doctors who hold two-year contracts. I again express the Government's appreciation of the major contribution NCHDs make to the delivery of front-line care and our commitment to the achievement of compliance with the European working time directive by 2014.

Senator Colm Burke

I very much appreciate the reply. It is specifically the Minister, Deputy James Reilly's, area. I am still at a loss as to how we can offer two-year contracts to persons outside this country and we cannot get information about what two-year contracts are in existence with Irish graduates. I am at a loss as to how we can offer two-year contracts in this way when we cannot do the same with junior doctors.

On the 80% who are on training courses, I accept they are on training programmes but their contracts are still only six-months or 12-month contracts where it is not structured. They are on training programmes under the various training colleges, but it is not structured. The specialist registrar programme is structured, but for those who are SHOs it is not structured. This is the reason we will lose a significant number of junior doctors in the next 12 months to two years. We must change the system.

We now face a situation where there is an added problem in that the number of those applying for consultant posts in Ireland has dropped, from an average of eight applicants per job to an average of two applicants per job, and this is a contributing factor. I ask that the Department would deal with this as a priority. I do not accept the answers being given to us by the HSE.

Deputy Kathleen Lynch

The course on which the Minister is set is about changing the system. It is a big unwieldy system and it will take time to change.

On the information the Senator is seeking, it is estimated there are on six-month contracts, approximately 2,000 senior house officers and registrars and some specialist registrars; on one-year contracts, 570 interns, approximately 300 senior house officers and registrars, and approximately 900 specialist registrars; on two-year contracts, some specialist registrars, 230 senior house officers and registrars on supervised divisions; on four-year contracts, 156 GP registrars; and on contracts of indefinite duration, approximately 600. As the Senator can see, it is an incredible amount of staff. I agree it is not ideal. The gaps, in terms of employment and delivery, are a significant issue for us and something about which we need far more certainty.

Senator Colm Burke

I thank the Minister of State.

Youth Services Funding

Senator Trevor Ó Clochartaigh

Gabhaim buíochas leis an Aire Stáit as ucht fanacht le haghaidh na ceiste seo.

I raise an issue on behalf of Youth Work Ireland in Galway. The voluntary board of Youth Work Ireland Galway met on Wednesday, 27 February, and the directors were deeply shocked that the allocations from the Department of Children and Youth Affairs were being cut retrospectively by 10% to 1 January 2013. They had based their budgets on a 6.5% cut. Maintaining service provision on a cut of 6.5%, it was already proving difficult for them to implement without funding raising, but the direct result was having a compounded effect.

In addition, they also want to find out the rationale for removing the administration of their funding from Youth Work Ireland national office to a local Dublin VEC organisation, the City of Dublin Youth Service Board. This, according to them, is the same organisation responsible for administering student grants through SUSI - we know what SUSI has got up to in the past couple of months. Throughout most of 2012, they were led to believe that if a transfer from Youth Work Ireland were to happen it would be to the local VEC, the Galway city or county VEC.

The impact of the 10% cut in funding in Youth Work Ireland Galway will be at least one addition to the dole queue, according to themselves. While one more unemployed person may not seem significant, the loss to the service would be the removal of supports to 12 voluntary youth clubs, 153 youth leaders, 464 young people as well as the only child protection awareness trainer in Youth Work Ireland Galway. The provision of youth club supports is core to the service Youth Work Ireland Galway gives and the Minister of State can imagine how strongly the board believes it is no longer in a position to deliver this service. In addition, given the abolition of the redundancy rebate on 1 January 2013, it is a significant cost to a charitable organisation such as this. The Minister of State will understand their sense of frustration.

I note that, apparently, the cut of 10% had been known previously, but it was not communicated to Youth Work Ireland Galway by the City of Dublin Youth Service Board. They want to know why this was not communicated previously. If, for example, the funding mechanism had transferred to a local VEC, the method of making cuts might have been quite different and might have been made in a manner more suitable to the type of work done by this important organisation.

Youth Work Ireland Galway is a voluntary organisation that works with young people in Galway city and county and has done so since the 1970s. It grew out of the youth club movement. We just had a debate on LGBT rights and I note that one of the organisations that Youth Work Ireland Galway supports is the shOUT! LGBT youth group. It also supports many other important youth groups.

It is a most important question. My party would like to see continued support for these youth groups. We would be concerned, not only that this cut been brought in a retrospective manner which makes it difficult for such organisations to budget but that there are also threats that perhaps more cuts are coming down the line. Perhaps the Minister of State can allay our fears and explain why this change has happened in such a manner.

Deputy Kathleen Lynch

I am taking the debate on behalf of the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald, and thank the Senator for raising it.

We are conscious of the considerable benefits that can accrue to young people from involvement in youth work, and the benefits for society as a whole. Youth projects and youth organisations present valuable opportunities for the social and personal development of young people. In 2013, the Department of Children and Youth Affairs will provide some €53.2 million to support the delivery of a range of youth work programmes and youth services, delivered to some 400,000 young people by over 1,400 youth work personnel, who, in turn, support a large volunteer base of 40,000. The focus of this financial support in 2013, as in previous years, is on the consolidation of existing youth work provision and on the safeguarding in so far as possible of front-line programmes and services, including those provided to young people in disadvantaged communities.

The comprehensive review of expenditure, CRE, published in December 2011, set out the savings required from the Department of Children and Youth Affairs in each of 2012, 2013 and 2014. The CRE contains a detailed seven-page chapter outlining savings required from youth work funding. The CRE clearly indicated a 10% saving requirement in 2013, with a lesser saving in 2014. Notwithstanding these savings, I understand funding of €129,481 is being allocated to Youth Work Ireland projects in Tuam, Loughrea and east Galway in 2013 under the special projects for youth scheme with a further €49,001 being provided for the Youth Information Centre in Ballinasloe.

The Department of Children and Youth Affairs has been examining the scope for improving administrative arrangements for the financial management of the funding for projects to achieve greater efficiency and standardisation. This includes, from this year, affording grant-administering bodies the flexibility to manage and re­allocate funding across the various existing separate funding streams so as to better manage savings locally and to facilitate youth service providers to refocus provision to ensure it meets local needs.

In addition, the Department has sought to rationalise the number of grant-administering bodies. As part of this, the City of Dublin Youth Service Board, CDYSB, was appointed to carry out financial management tasks related to the administering of allocated funding for a number of projects whose funding has previously been administered directly by six national organisations, including Youth Work Ireland.

It should also be noted that under the comprehensive review of expenditure, there has been no cut to the funding being provided to support local voluntary youth clubs. This modest funding, in excess of €1 million, plays an important role in supporting volunteer-led youth groups and in promoting and leveraging valuable voluntary activity in youth work.

With respect to future funding provision, the Department of Children and Youth Affairs has commenced a formal and comprehensive value for money review of youth funding and this is expected to report later this year. In addition, the Minister yesterday announced the opening of applications for a new €1 million youth café funding scheme. This follows on from funding of €500,000 which was provided in 2012 for the development of a number of youth cafés which had applied for previous youth café funding schemes.

Senator Trevor Ó Clochartaigh

In the correspondence I received Youth Work Ireland Galway disputed the figure of a 10% cut indicated in the comprehensive review of expenditure. Youth Work Ireland Galway stated it had worked out the figure was 6.5% figure. It was stated discretion was given to the City of Dublin Youth Service Board which allocated the funding, but it had chosen to apply a 10% cut across the board, which may not be the best for the Galway-based organisation. I ask the Minister of State to bring back to the Minister that there should be some form of consultation with the Galway organisation to see whether the cuts can be implemented in another way which would not put the job or services in jeopardy.

Deputy Kathleen Lynch

Sometimes what happens - the Senator probably realises this himself - and I find it particularly with regard to disability services, is that somehow or other organisations come to a notional view themselves what a cut will be. It seems very obvious to me that the background information clearly states a flat 10% saving requirement would be applied across all funding lines in 2013. The comprehensive review of expenditure nowhere references a 6.5% saving. As the Senator correctly pointed out, in 2012 savings of either 5% or 10% were required from various schemes. This would subsequently average out at 6.5% and perhaps this is from where the misinformation came. This can sometimes happen. I will most definitely bring the Senator's remarks to the Minister.

The Seanad adjourned at 7.30 p.m. until 10.30 a.m. on Thursday, 14 March 2013.