I propose to take Questions Nos. 186 and 199 together.
The Government is committed to achieving compliance with the European Working Time Directive in respect of non-consultant hospital doctors (NCHDs) by 2014. I have emphasised to the HSE the high priority the Government and I attach to this issue.
In January 2012, a detailed plan for the achievement of compliance by NCHDs with the Working Time Directive was submitted to the EU Commission. The plan affirmed Ireland's commitment to achieving compliance with the Directive over a three-year time period. It committed to implementing the measures necessary, including: new work patterns for medical staff, transfer of work undertaken by NCHDs to other grades, and the organisation of hospital services to support compliance. Compliance with the directive is of benefit to NCHDs and also supports patient safety. The Health Service Executive’s Service Plan for 2013 specifically recognises the need to address the issue as a priority, stating that there will be a particular focus in the acute hospital service on the achievement of compliance with the European Working Time Directive amongst the non-consultant hospital doctor workforce, in line with the Implementation Plan submitted to the Commission in 2012. The HSE is currently finalising its National Operational Plan to support the implementation of the National Service Plan 2013. This will specify in greater detail the actions to be taken during the year in relation to EWTD compliance. A key priority for the HSE in 2013 will be a further reduction of average weekly hours worked and also a reduction in the duration of shifts undertaken.
S.I. No. 494 of 2004 European Communities (Organisation of Working Time) (Activities of Doctors in Training) Regulations 2004, which transposed the EU Working Time Directive for doctors in training, provides for:
- A maximum 48 hour average working week;
- A 30 minute rest break every 6 hours during period on-site on-call;
- 11 hours rest every 24 hours or equivalent compensatory rest before return to work; and
- 35 hours continuous rest per week or twice a fortnight or 59 hours continuous rest per fortnight.
The 2010 Contract of Employment for NCHDs, which these staff sign on appointment, reflects the above provisions. The contract also provides that NCHDs shall not be required to work more than 24 consecutive hours on-site. A related agreement between the HSE and the Irish Medical Organisation provides that the contract is subject to the requirements of the Directive.
As part of the measures agreed between health service management and the consultant representative bodies at the Labour Relations Commission in September 2012, consultants will support the implementation of required revisions to NCHD work patterns and reduction in NCHD working hours to comply with the provisions of the EWTD. These include ward-based rostering, use of cross cover at SHO level, replacement of NCHD hours by Advanced Nurse/Midwifery Practitioner hours where appropriate, transfer of certain duties to other staff and other measures set out in Ireland's 2012 Plan to drive EWTD compliance.
I want to ensure that NCHDs can progress to consultant level. However, it is not sustainable, in the light of the State's serious financial difficulties, to continue to recruit at the previous rates. If we are to continue to provide consultant-level career opportunities for doctors and, subject to the limitations on available resources, to replace consultants who retire and where possible expand overall capacity, this can only happen on the basis of a lower-cost model.
I have asked the Executive to reply directly to the Deputy in relation to the range of hours worked by NCHDs in the public health service and the number of risk assessments that have been carried out in the past two years.
