Dáil Éireann Debate, Wednesday - 15 May 2019
1. Deputy Stephen Donnelly asked the Minister for Health his views on whether Ireland has a severe shortage of hospital consultants; his further views on whether a major reason for same is new entrant pay disparity; his plans to rectify same; the number of consultants employed at post-2012 pay rates; and if he will make a statement on the matter. [21143/19]
View answerAs the Minister and I are both aware, the waiting lists for public access to hospital consultants across the board are at the worst levels since records began. Does the Minister accept that one of the main reasons people have to wait so long is that we have a severe shortage of hospital consultants? Does he also accept that one of the core reasons for that is the significant discrepancy in pay between new entrants and existing consultants?
The number of consultants working in the public health service continues to grow year-on-year. It increased by 119 whole-time equivalents, WTEs, or 4% in the year to the end of March 2019. In the five years to the end of March 2019, the number of consultants increased by 529, more than 20%, and now stands at 3,110 WTEs. It is important in any discussion of this issue to acknowledge that while there is a recruitment and retention challenge relating to consultants, the impression is often given that the number is declining when it is increasing. There are 119 more consultants working in the health service at the end of March this year compared with last year.
The public health service in Ireland operates in a global market for medical specialists and there is a worldwide shortage of specialists. Notwithstanding the shortage, progress continues to be made in attracting consultants and addressing improvements in the training, working environment and career pathways for non-consultant hospital doctors in Ireland to encourage the supply of future consultant candidates.
The issue of new entrant pay is being addressed in general terms under the terms of the Public Service Stability Agreement 2018-2020. The issue has also been examined by the Public Service Pay Commission in relation to consultants. The commission found that evidence of recruitment campaigns with very low levels of applications was indicative of ongoing difficulties in regard to recruitment of consultants. The commission also acknowledged that the difference in pay between the pre-existing and new entrant consultants is greater than for other categories of public servants. It did not view the measures announced last September for new entrant public servants generally as being sufficient to address the degree of pay differential which exists for consultants and I share that view. Ultimately, the commission proposed that the parties to the public service stability agreement jointly consider what further measures could be taken, over time, to address this difficulty.
I understand that the Department of Public Expenditure and Reform has noted the commission’s views. The recommendation made by the commission in relation to addressing the pay differential is viewed as one which does need to be addressed. We acknowledge that brokering a solution will be a significant challenge, in particular within the context of broader public sector pay policy. It should also be acknowledged, and I am sure the Deputy will agree with me in this regard, that while pay is a factor, there are a number of other factors, as many reports have shown. I refer, for example, to opportunities for career development, training opportunities and location. The commission stated it was strongly supportive of the full implementation of the recommendations of the Strategic Review of Medical Training and Career Structures, known as the MacCraith recommendations, as they have the potential to resolve many of the issues. As I said at the Irish Medical Organisation, IMO, conference, we must now put a process in place to engage with consultants on the issue.
The concern is speed because we are facing a crisis. As some senior hospital consultants said to me just last week, the public hospital system is now on fire. It is great that we have, notionally, 3,100 consultants but there are approximately 400 unfilled positions, more than are 300 locums included in the number and there are at least 150 non-specialists acting in specialist roles. When one counts all of that, there are not 3,000 but closer to 2,000 consultants. Even if we had the 3,000 posts all filled by full-time, fully qualified specialists, which we do not, the number of consultants would still be approximately 43% below the EU average. We have a chronic shortage of doctors and the reality is that people are waiting longer in Ireland than in any other country in Europe to see doctors. It worries me when I hear language to the effect that "we will put a process in place" because these are the kinds of things that can take years. Does the Minister accept that we have an immediate crisis in terms of a shortage of hospital consultants and that something needs to be done urgently to address that, including dealing with pay disparity?
I outlined my position very clearly in that regard at the IMO conference in Killarney a couple of weekends ago and I am happy to outline it again here. Addressing consultants and their concerns is the next major issue we need to resolve. I say that from the position that we have just reached an agreement with general practitioners, which is still being considered by the Irish Medical Organisation. There was scepticism in this House as to whether that would happen. It has happened and it has been warmly welcomed by many GPs. An agreement reached with nurses was accepted by more than 60% of nurses in a ballot for a new nurses' contract. The next obvious area that we must work on is consultants. That will require a process. I have had talks with the Irish Hospital Consultants Association, IHCA. I have also had talks with the IMO in recent weeks on those matters and I will work with Government colleagues to work out how best to design a process, one that respects the public sector pay parameters within which we have to operate.
There are other factors above and beyond pay, including, for example, some of the factors that the Sláintecare committee highlighted in relation to the de Buitléir report and the concept that we should not have private practice taking place in public hospitals. There is a multitude of issues when it comes to the point Deputy Donnelly makes regarding access.
The question then is "When?". We know there is not much competition for open posts. Between 2015 and 2016, a total of 44 consultant psychiatrist posts were advertised. A quarter of them did not even attract one applicant and another 30% of posts had only one applicant. We know that many hospitals are running out of specialists. In Kerry, for example, they are running out of any individual consultant to provide services in histopathology, rheumatology and urology in some of the more rural hospitals.
Sláintecare requires consultants. The national children's hospital will require consultants. Serious pressure is being put on the system justifying the specialists to fill the satellite centres for launch in one or two months' time. As I said, the question is "When?" We need to ramp up the number of consultants all over the country, not just in the big hospitals.
Can the Minister provide a broad outline of when he expects the process to be concluded and pay disparity to be addressed, rather than when he hopes the process will start? When might the consultants see a solution to pay disparity implemented?
I cannot give a definitive timeframe for that because these processes require two sides being willing to negotiate an outcome. When we engaged with the GPs, for example, a massive amount of intensive work was required. When we engaged with GPs and then with nurses, after they took the significant step of industrial action, which they did not take lightly, both sides had requests. It will be similar in this instance.
The Deputy correctly referred to the Sláintecare report. The country absolutely needs more consultants and we must examine the pay of those consultants, but we also must examine how we provide our health services and implement the recommendations of the Sláintecare report. I expect both sides, including the health service management side, to have a list of requests regarding how to ensure that we can recruit and retain more consultants, pay them properly, respect them and give them good working conditions, and also on what the health service will look like over the course of the delivery of Sláintecare. The question of when will be a matter for the Government to consider. I am currently engaging with my colleagues on that.
