Dáil Éireann Debate, Wednesday - 26 May 2004
105 Ms B. Moynihan-Cronin asked the Minister for Health and Children the position regarding the application of the European working time directive to non-consultant hospital doctors; if he will give the latest assessment of the implications for staffing levels in hospitals; and if he will make a statement on the matter. [15587/04]
View answer107 Mr. Gogarty asked the Minister for Health and Children when Ireland will be able to comply with the European working time directive; and if he will make a statement on the matter. [15720/04]
View answer187 Mr. Durkan asked the Minister for Health and Children the way he sees the working time directive being implemented and the extent to which he expects extra staff to be recruited in order to comply; and if he will make a statement on the matter. [15959/04]
View answerI propose to take Questions Nos. 105, 107 and 187 together.
The European working time directive, EWTD, requires a reduction in the average weekly working hours of non-consultant hospital doctors, NCHDs, to 58 hours by 1 August 2004 and ultimately to 48 hours by 2009. The national task force on medical staffing or Hanly report has re-iterated the measures that must be progressed to reduce NCHD hours, while providing safe, high quality acute hospital services, 24 hours a day, seven days a week.
Responsibility for human resource planning rests with the chief executive officer, CEO, of each health board. Each CEO in managing the workforce in his or her region is responsible for determining the appropriate staffing mix and the precise grades of staff to be employed in line with service plan priorities, subject to overall employment levels remaining within the approved regional employment ceiling. As far as medical personnel are concerned, the Hanly report details the number of consultants and non-consultant hospital doctors that will be required in the coming years to provide a high quality, consultant provided service. An implementation phase will obviously be required to achieve this re-configuration.
The report of the national joint steering group on the working hours of non-consultant hospital doctors identified a range of activities which could be delivered by other health professionals within a multi-disciplinary team. It suggested a reconfiguration of service and enhanced skills mix which could improve the quality of service to patients. This would also enhance the skills and broaden the range of capabilities of other health professionals. Work has been ongoing in implementing these recommendations. One example of this is the imminent introduction of a new training programme for phlebotomists which is expected to come into operation this year. It is clear, however, that more work must be done and that full co-operation from all stakeholders is now required to establish groups at local level, incorporating the appropriate mix of doctors, nurses, local management and other grades.
A national co-ordinator and support team have been seconded to oversee the implementation of the European working time directive in the health agencies. In addition, medical manpower managers, appointed as part of the NCHD 2000 agreement, are helping to oversee the reduction in NCHD working hours on the ground. They are playing an essential role in the phased implementation of these aspects of the Hanly report and helping to ensure compliance with the requirements of the directive. Latest returns indicate that in excess of 60% of NCHDs will be compliant with the 58 hours requirement of the directive by 1 August 2004. Difficulties will arise, however, in the specific provisions of the directive relating to rest breaks and compensatory rest. These issues are being actively considered and will be progressed on an ongoing basis.
Time is of the essence in the process. Management representatives have been ready and willing to participate in local working groups, representative of key stakeholders, to implement these measures. These groups would also monitor progress in relation to the reduction in NCHD hours. One of the problems facing management in implementing the directive's requirements is the lack of substantive engagement by the Irish Medical Organisation, IMO, the Irish Hospital Consultants Association, IHCA, and the medical training colleges. The refusal of the IMO to establish or participate in local implementation groups, the failure to reach any agreement on the industrial relations issues and the limited and individualised response from the colleges on the training/rostering issues are causing significant and ongoing difficulties with implementation. The difficulties being faced in this regard have already been outlined to the European Commission in the Department's response to its consultation document on the review of the European working time directive.
Management has also been pressing to establish a national implementation group to co-ordinate the work being undertaken at local level — to provide guidance and to monitor progress. These groups at both national and local level should include appropriate hospital managers, consultants, NCHDs and other relevant health care professionals. The need to establish these groups has been discussed with the Irish Medical Organisation at the ongoing meetings in the Labour Relations Commission. Full co-operation is vital in establishing these groups to implement these measures that the medical organisations have been lobbying for many years to achieve.
The deadlines imposed by the European working time directive will be difficult to meet, assuming the full co-operation of the key stakeholders concerned. Without that co-operation the challenges and difficulties which must be surmounted are considerably greater. I again call on the stakeholders concerned to participate with and co-operate with the necessary implementation processes. It is important to state that we face the same hurdles as many of our EU colleagues. They, too, are grappling with how to provide top quality health services while complying with the requirements of the directive. Every effort is being made to comply with the requirements of the directive. The current difficulties in no way alleviate our legal obligations and only serve to emphasise the growing urgency of making the necessary progress to achieve implementation. I again call on all interested parties to play their part in achieving a healthier and safer working environment for doctors in training and, equally important, the safer provision of services to patients.
