Dáil Éireann Debate, Tuesday - 22 June 2004
55 Ms McManus asked the Minister for Health and Children the position regarding the application of the European working time directive to non-consultant hospital doctors; the details of the latest assessment of the implications for staffing levels in hospitals; and if he will make a statement on the matter. [18358/04]
View answer88 Mr. McCormack asked the Minister for Health and Children if he has satisfied himself that the State’s health service will comply with the European working time directive for non-consultant hospital doctors by the deadline of 1 August 2004; and if he will make a statement on the matter. [18439/04]
View answer194 Dr. Cowley asked the Minister for Health and Children the outcome of negotiations which have taken place between his Department and the unions representing managerial staff, ECG technicians, phlebotomists, ward clerks, porters and others with a view to ending the practice whereby up to 17% of the long hours worked by NCHDs is accounted for by carrying out at night and at weekends hospital duties more appropriate to these grades; and if he will make a statement on the matter. [18510/04]
View answer195 Dr. Cowley asked the Minister for Health and Children if he intends to allocate additional funding to give effect to the European working time directive; the contingency arrangements he has prepared, including the curtailment of services when dictated by inadequate medical staffing, in the absence of sufficient extra staffing and resources to enable the introduction of the directive; and if he will make a statement on the matter. [18511/04]
View answerI propose to take Questions Nos. 55, 88, 194 and 195 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 which produced the Hanly report has reiterated 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 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 reconfiguration. The ability to deliver effective training to our doctors while maintaining a demanding medical service in a new model is significant in its own right. I am convinced, however, that this also presents a unique opportunity to improve training, services and the working lifestyles of all NCHDs.
The Deputies will be aware that the report of the national joint steering group on the working hours of non-consultant hospitals doctors identified a range of activities which could be delivered by other health professionals within a within a multidisciplinary team. It suggested a reconfiguration of service and enhanced skills mix which could improve the quality of service to patients and remove inappropriate duties from NCHDs. 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 later 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 to progress these discussions on skill mix issues.
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 ensuring full compliance with the specific provisions of the directive, especially those relating to rest breaks and compensatory rest. These issues are being actively reviewed and progressed on an ongoing basis in so far as is possible without having the substantive engagement or necessary agreement of the Irish Medical Organisation.
As the Deputies are aware, time is of the essence in this process. Management representatives have been ready and willing to participate in local working groups, representatives 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, the Irish Hospital Consultants' Organisation and some of 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 some of the colleges on the training-rostering issues are causing significant and ongoing difficulties in relation to 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 healthcare 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 from all the relevant stakeholders is vital in establishing these groups, to implement these measures that the medical organisations have been lobbying for many years to achieve.
I am aware that resource requirements may arise in the context of the work to be undertaken by both the local and national groups when agreement to their establishment is finally obtained. Such requirements will be considered in the context of the overall agreement that must be reached in relation to the implementation of the directive.
Responsibility for service provision within each health board-region is a matter for each chief executive officer concerned. This includes the preparation of contingency arrangements to address any situation which might affect the provision of services.
The deadlines imposed by the European working time directive will be difficult to meet, assuming the full co-operation of the key stakeholders concerned. I again call on the stakeholders concerned to participate with and co-operate with the necessary implementation processes. I think 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 has been made and continues to be made to achieve compliance. 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.
