Thursday, 26 September 2013

Questions (5)

Caoimhghín Ó Caoláin


5. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the action he will take to ensure immediate progress in reform of hospital medical staffing and in our medical training and recruitment system to ensure compliance with the European working time directive for non-consultant hospital doctors, to recruit and deploy doctors in sufficient numbers and appropriate grades, including new grades as required, and provide a proper career path to guarantee safe practice, better working conditions and improved care for patients; and if he will make a statement on the matter. [40228/13]

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Oral answers (7 contributions) (Question to Health)

Ireland must have sustainable arrangements to train and develop the medical workforce we need to provide safe and effective services to our population. For that reason, I am committed to retaining in our health service doctors who are educated and trained in Ireland. I intend to do this by providing them with clear career pathways and appropriate working conditions. I think the lack of such requirements is one of the main reasons many of our young doctors are leaving. The Government is committed to achieving compliance with the European working time directive in relation to non-consultant hospital doctors by the end of 2014. At my request, the HSE established a national group earlier this year to bring an urgent focus to the implementation of the working time directive. This group has been working closely with hospitals. There has been progress on a number of interim targets relating to the number of doctors working more than 24 hours in a single shift and instances of doctors working more than 68 hours a week. I am confident that progress will continue to be made towards the objective of full compliance.

I welcome this week's decision by the Irish Medical Organisation to suspend its threat of industrial action by non-consultant hospital doctors. This followed last week's discussions under the auspices of the Labour Relations Commission. A further meeting of the parties is taking place today. I hope it will be possible to resolve the issues of concern in a way which does not involve disruption of services to the public. In July of this year, I set up a working group chaired by Professor Brian MacCraith, who is the president of Dublin City University, to carry out a strategic review of the medical training and career structure of non-consultant hospital doctors with a view to improving the retention of graduates in the public health system. In particular, I want the group to set out a clear pathway for training at every level from intern to specialist and to examine the potential for reducing the length of specialist training. I see this as a modernising initiative which is needed urgently. I have asked Professor MacCraith to provide an interim report to me by the end of November 2013 and a final report by the end of June 2014.

I am very keen for this matter to be resolved. I want to send a message to the young men and women who study hard to achieve high points in the leaving certificate, and who study so hard for a further five years at college to become doctors, that there is a future here for them. We need them and we value them. We should respect them. I certainly do, even if others have not in the past.

They certainly have my respect. We all welcome the fact that the strike action that was due to take place yesterday has been suspended or deferred. It is important that there has been engagement between the Irish Medical Organisation and the HSE. In his response, the Minister referred to "compliance ... by the end of 2014". Can he confirm that the HSE has agreed to a timetable for the implementation of the European working time directive, with compliance beginning from early January 2014? That date, which is a short number of months from now, is just after the start of the next rotation of junior doctors. Has the Department of Public Expenditure and Reform given a commitment to provide whatever resources are needed? We appreciate that resources will be needed in this situation. The Minister will certainly be very mindful of that in terms of the responsibility of his Department. Have commitments been made with regard to resources to ensure implementation of the directive?

In the past, everybody always looked to quantums of money and numbers of people. A change in the way we work is what is really required as we reform our health service. It should not be a question of asking people who are already working hard to work harder. It should be a question of asking them to work differently. I asked the HSE today why some model 4 hospitals - the big hospitals - have nine nurses for every health care assistant, while other hospitals of model 4 size have 2.8 nurses for every health care assistant. Non-consultant hospital doctors are being asked to do a great deal of work which they should not be doing and which could be done by others. The hospital groups will help in this regard. I want to put it on the record of the House that we have made considerable process in relation to this. No non-consultant hospital doctor now works more than 68 hours. That was our initial focus. I am not sure we are 100% there yet, but we are working towards that and on ensuring no shifts exceed 24 hours.

I welcome the Minister's acknowledgement that we need to address some of the core issues here, including career path issues. Does the Minister accept that the virtual crisis situation with junior doctors has continued year after year? Does he agree that fundamental reform along the lines of what he indicated at the outset of his reply is long overdue? The elements of reform are well known and were set out in my question. Can the Minister tell us whether he is making progress with the new grades that are required, or with the necessary increase in the number of consultant posts? He referred to those who achieve the highest performance rates in the leaving certificate. What is he doing to open medical training to more of our young people and not just those from privileged backgrounds - I do not suggest that all medical students come from such backgrounds - or those who attain 600 points in the leaving certificate? I have seen the great disappointment of young people who have done exceptionally well in the leaving certificate but have been excluded from these requirements even though they have the necessary attributes to prove to be among the most caring and dedicated of doctors in the future.

Of course education is a matter for the Minister for Education and Skills. While no system is perfect, the leaving certificate is about the most transparent and fair system we have. I have already placed on the record my distaste for the health professions admission test. Its introduction has led to the development of a new industry that involves educating people in how to pass the test. It has been proven that people who have failed the test have subsequently passed it after going away and doing a course. It is not really doing what it is supposed to do in terms of testing aptitude in a genuine fashion.

I want to give the House some positive news. There are an extra 200 non-consultant hospital doctors since this Government took office. The Deputy asked about consultants. There are another couple of hundred of them as well. Overall medical manpower has increased by approximately 420. According to a 2009 survey, non-consultant hospital doctors worked an average of 60 hours a week. HSE data from 2012 indicate that non-consultant hospital doctors work an average of 54 hours a week. There will be exceptions because these are average figures. Data for the first six months of 2013 show that there has been a further reduction to 52.4 hours per week. The percentage of non-consultant hospital doctors working shifts in excess of 24 hours decreased from 58% in March 2013 to 24% in August.

Further progress needs to be made. We are very pleased to be co-operating with the IMO and NCHDs in this regard. I want to address the other issues that affect them in terms of the lack of a career path.

Would the Minister create a new grade to help their career path structure?

No, I did not say that. I want to shorten their training. I do not see why one can become a fully trained specialist in Australia in six years and yet it takes, on average, 12 years here. That is not acceptable and is not fair on people. It strikes me that we have many people who are very experienced at a lower grade doing an awful lot of the work when they should already be in that specialist grade and out there as specialists. That is what I want to see.